Outcome predictors and new score of critically ill cirrhotic patients with acute renal failure

Abstract

Background. End-stage liver disease is often complicated by renal function disturbances. Cirrhotic patients with acute renal failure admitted to intensive care units (ICUs) have high mortality rates. This work seeks to identify specific predictors of hospital mortality in critically ill cirrhotic patients with acute renal failure. Methods. A total of 111 patients with cirrhosis and acute renal failure were admitted to ICU from March 2003 to February 2005. Twenty-six demographic, clinical and laboratory variables were prospectively gathered as predictors of survival on the first day of ICU admission. Results. The overall hospital mortality rate was 81.1%. The univariate analysis identified 11 of the 32 variables as prognostically valuable. The multiple logistic regression analysis (excluding five scoring systems) indicates that the mean arterial pressure (MAP), serum bilirubin, respiratory failure and sepsis on the first day in ICU are significantly related to prognosis. The best Youden index (sensitivity + specificity − 1) yields cutoff points of 80 MAP (in mmHg) and 80 serum bilirubin (in µmol/L) (or 4.7 mg/dL) and indicates acute respiratory failure and sepsis. A simple model for mortality is developed on the basis of these four readily available parameters on Day 1 of ICU admission. The new score (MBRS score: MAP + bilirubin + respiratory failure + sepsis) displays an excellent area under the receiver operating characteristic curve (0.898 ± 0.031, P < 0.001). The mortality rate exceeds 90% when the MBRS (MAP + bilirubin + respiratory failure + sepsis) score is 2 or higher. Conclusion. The MBRS score is a straightforward, reproducible and easily adopted evaluative tool with good prognostic abilities, which generates objective data for patient families and physicians and supplements a clinical judgment of prognosis.

KDIGO (Kidney Disease: Improving Global Outcomes) criteria as a predictor of hospital mortality in cirrhotic patients

“…Also, the AKI prevalence was lower than in the studies in the literature, most of which were done with ICU patients. Different mortality rates ranging from 11% to 81% are also reported in the literature (25,26), while in our study, the overall mortality rate was 15.5%.…”

RIFLE classification as predictive factor of mortality in patients with cirrhosis admitted to intensive care unit

“…Cr Ն 3.5 mg/dL [Ն 309.4 mmol/L] or oliguria [< 500 mL/day]), or the presence of HRS or need for hemofiltration. Although in contrast to the two previous studies 7,29 (from the same centre), we used a combination of Cr and diuresis to define ARF, neither our study, 9 nor these previous ones 7,29 evaluated the impact of different degrees of renal dysfunction (from normal kidney function to complete renal failure) on mortality.…”

“…For example, Chen et al 7 evaluated cirrhotic patients considering ARF as the presence of Cr Ն 1.5 mg/dL (Ն 132.6 mmol/L) ( Table 7); ARF on admission was associated with a high ICU mortality rate (86.6%). Similarly, Fang et al 29 from the same centre, evaluated 111 different cirrhotics with renal dysfunction. ARF was defined as Cr Ն 1.5 mg/dL (Ն 132.6 mmol/L) or a 50% rise in Cr from baseline or the need for hemofiltration (the first two criteria were based on the 1st stage of severity [Risk] of ARF according to the RIFLE classification) ( Table 7).…”

Acute kidney injury classification: AKIN and RIFLE criteria in critical patients

“…In order to identify specific predictors of hospital mortality in critically ill cirrhotic patients with AKI, Fang et al [18] evaluated 111 critically ill cirrhotic patients with AKI (RIFLE-R, I, or F) or a rise in SCr level over 1.5 mg/dL (132.6 μmol/L) using prospectively collected data. Mean arterial pressure (MAP), serum bilirubin, acute respiratory failure, and sepsis on the first day in ICU were significantly related to prognosis.…”

“…Sepsis is also a well-known risk factor for AKI; 35%-50% of AKI cases in ICUs are attributable to sepsis [18,22,23] . Severe sepsis and septic shock are defined according to modified the American College of Chest Physicians and Society of Critical Care Medicine consensus criteria [24] .…”