PIRO-CIC model can predict mortality and futility of care in critically ill cirrhosis patients in the intensive care unit

Maiwall, Rakhi; Pasupuleti, Samba Siva Rao; Tevethia, Harsh Vardhan; Sarin, Shiv Kumar

doi:10.1007/s12072-022-10426-4

Cited by 3 publications

(2 citation statements)

References 38 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…and ICU based prognostic scores. 10,163,[209][210][211][212][213][214][215][216][217][218][219][220] The cost-effectiveness of intensive care management proto-…”

Section: Specialised Nursing Carementioning

confidence: 99%

See 1 more Smart Citation

Review article: Evaluation and care of the critically ill patient with cirrhosis

Kosuta,

Premkumar,

Reddy

2024

Aliment Pharmacol Ther

View full text Add to dashboard Cite

SummaryBackgroundThe increase in prevalence of liver disease globally will lead to a substantial incremental burden on intensive care requirements. While liver transplantation offers a potential life‐saving intervention, not all patients are eligible due to limitations such as organ availability, resource constraints, ongoing sepsis or multiple organ failures. Consequently, the focus of critical care of patients with advanced and decompensated cirrhosis turns to liver‐centric intensive care protocols, to mitigate the high mortality in such patients.AimProvide an updated and comprehensive understanding of cirrhosis management in critical care, and which includes emergency care, secondary organ failure management (mechanical ventilation, renal replacement therapy, haemodynamic support and intensive care nutrition), use of innovative liver support systems, infection control, liver transplantation and palliative and end‐of life care.MethodsWe conducted a structured bibliographic search on PubMed, sourcing articles published up to 31 March 2024, to cover topics addressed. We considered data from observational studies, recommendations of society guidelines, systematic reviews, and meta‐analyses, randomised controlled trials, and incorporated our clinical expertise in liver critical care.ResultsCritical care management of the patient with cirrhosis has evolved over time while mortality remains high despite aggressive management with liver transplantation serving as a crucial but not universally available resource.ConclusionsImplementation of organ support therapies, intensive care protocols, nutrition, palliative care and end‐of‐life discussions and decisions are an integral part of critical care of the patient with cirrhosis. A multi‐disciplinary approach towards critical care management is likely to yield better outcomes.

show abstract

“…and ICU based prognostic scores. 10,163,[209][210][211][212][213][214][215][216][217][218][219][220] The cost-effectiveness of intensive care management proto-…”

Section: Specialised Nursing Carementioning

confidence: 99%

“…A CLIF‐C ACLF score cut off ≥70 at 48 h of ICU admission was associated with a 100% 28‐day mortality, and as such is an indicator of futility. Table S4 informs about Liver and ICU based prognostic scores 10,163,209–220 …”

Section: Introductionmentioning

confidence: 99%

Review article: Evaluation and care of the critically ill patient with cirrhosis

Kosuta,

Premkumar,

Reddy

2024

Aliment Pharmacol Ther

View full text Add to dashboard Cite

show abstract

Evaluation of acute kidney injury (AKI) biomarkers FABP1, NGAL, cystatin C and IL-18 in an Indian cohort of hospitalized acute-on-chronic liver failure (ACLF) patients

Saha,

Sharma,

Mondal

et al. 2024

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

Novel prognostic biomarkers in decompensated cirrhosis: a systematic review and meta-analysis

Juanola,

Ma,

de Wit

et al. 2023

Gut

View full text Add to dashboard Cite

BackgroundPatients with decompensated cirrhosis experience high mortality rates. Current prognostic scores, including the model for end-stage liver disease (MELD), may underperform in settings other than in those they were initially developed. Novel biomarkers have been proposed to improve prognostication accuracy and even to predict development of complications.MethodsWe performed a systematic review and meta-analysis on novel urine and blood biomarkers and their ability to predict 90-day mortality in patients with decompensated cirrhosis. Secondary outcomes included 28-day and 1-year mortality, and development of acute-on-chronic liver failure, acute kidney injury and other complications. To overcome differences in units, temporal changes in assays and reporting heterogeneity, we used the ratio of means (RoM) as measure of association for assessing strength in predicting outcomes. An RoM>1 implies that the mean biomarker level is higher in those that develop the outcome than in those that do not.ResultsOf 6629 unique references, 103 were included, reporting on 29 different biomarkers, with a total of 31 362 biomarker patients. Most studies were prospective cohorts of hospitalised patients (median Child-Pugh-Turcotte score of 9 and MELD score of 18). The pooled 90-day mortality rate was 0.27 (95% CI 0.24 to 0.29). The RoM for predicting 90-day mortality was highest for interleukin 6 (IL-6) (2.56, 95% CI 2.39 to 2.74), followed by urinary neutrophil gelatinase-associated lipocalin (uNGAL) (2.42, 95% CI 2.20 to 2.66) and copeptin (2.33, 95% CI 2.17 to 2.50). These RoMs were all higher than for MELD (1.44, 95% CI 1.42 to 1.46).ConclusionNovel biomarkers, including IL-6, uNGAL and copeptin, can probably improve prognostication of patients with decompensated cirrhosis compared with MELD alone.

show abstract

PIRO-CIC model can predict mortality and futility of care in critically ill cirrhosis patients in the intensive care unit

Cited by 3 publications

References 38 publications

Review article: Evaluation and care of the critically ill patient with cirrhosis

Review article: Evaluation and care of the critically ill patient with cirrhosis

Evaluation of acute kidney injury (AKI) biomarkers FABP1, NGAL, cystatin C and IL-18 in an Indian cohort of hospitalized acute-on-chronic liver failure (ACLF) patients

Novel prognostic biomarkers in decompensated cirrhosis: a systematic review and meta-analysis

Contact Info

Product

Resources

About