Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

Abstract

Aim: to assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), Model for End-stage Liver Disease (MELD) and ChildPugh-Turcotte (CPT) in predicting GICU mortality in cirrhotic patients.Methods: the study involved 124 consecutive cirrhotic admissions to a GICU. Clinical data, prognostic scores and mortality were recorded. Discrimination was evaluated with area under receiver operating characteristic curves (AUC). Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test.Results: GICU mortality was 9.7%. Mean APACHE II, SAPS II, SOFA, MELD and CPT scores for survivors (13.6, 25.4, 3.5, 18.0 and 8.6, respectively) were found to be significantly lower than those of non-survivors (22.0, 47.5, 10.1, 30.7 and 12.5, respectively) (p < 0.001). All the prognostic systems showed good discrimination, with AUC = 0.860, 0.911, 0.868, 0.897 and 0.914 for APACHE II, SAPS II, SOFA, MELD and CPT, respectively. Similarly, APACHE II, SAPS II, SOFA, MELD and CPT scores achieved good calibration, with p = 0.146, 0.120, 0.686, 0.267 and 0.120, respectively. The overall correctness of prediction was 81.9%, 86.1%, 93.3%, 90.7% and 87.7% for the APA-CHE II, SAPS II, SOFA, MELD and CPT scores, respectively.Conclusions: in cirrhotics admitted to a GICU, all the tested scores have good prognostic accuracy, with SOFA and MELD showing the greatest overall correctness of prediction. INTRODUCTIONPrognostic models are used for comparison and quality assessment of different Intensive Care Units (ICUs) and within the same ICU over time, for audit and clinical research, for evaluating therapeutic effectiveness and for guiding discussions between clinicians and families (1-6).The incidence of liver cirrhosis is increasing exponentially and cirrhotic patients admitted to ICUs have high mortality rates and a high rate of consumption of resources (7-18). Furthermore, a significant percentage (36.7%) of the total cost of ICU care for cirrhotic patients is spent on those who do not survive (11,16,19). Additionally, it must be borne in mind that ICUs are a very limited health resource (10,11,18). Thus, predictive models could be very important decision-making tools in this setting.Two types of prognostic scores can be used in cirrhotics admitted to ICUs: general prognostic models and disease-specific models. The general prognostic models include two main categories: firstly, those evaluating severity of illness, namely the Acute Physiology and Chronic Health Evaluation (APACHE) II (20) and Simplified Acute Physiology Score (SAPS) II (21); secondly, models quantifying organ dysfunction and failure, of which the most widely-used is the Sequential Organ Failure Assessment (SOFA) (22,23 Vol. 103. N.° 4, pp. 177-183, 2011 Received: 04-10-10. Accepted: 02-12-10.

Clinical profile, natural history, and predictors of mortality in patients with acute-on-chronic liver failure (ACLF)

“…3Receiver operating characteristic curve of Acute Physiology and Chronic Health Evaluation (APACHE) II score the prognosis is determined by the degree of other organ system dysfunction and not by the severity of liver failure. Our findings are similar to those of other studies[1,2,4,[22][23][24][25][26][27][28][29][30].…”

Scoring Systems for Predicting Mortality after Liver Transplantation

“…Freire P et al showed that SOFA and MELD scores had better overall correctness than Child-Pugh score, APACHE II, and SAPS II scores in predicting ICU mortality [18]. Levesque E et al reported that SOFA and SAPS II scores predicted ICU mortality better than Child-Pugh score or MELD scores with or without the incorporation of serum sodium levels [19].…”

Intrarenal Resistance Index as a Prognostic Parameter in Patients with Liver Cirrhosis Compared with Other Hepatic Scoring Systems

“…Therefore, assessment of prognosis is important in the management of these patients. The Child-Pugh score has long been the most widely used specific scoring system in liver disease [2,3]. In 2002, the Model for End-Stage Liver Disease (MELD) was introduced for patients undergoing transjugular intrahepatic portosystemic shunt.…”

“…In 2002, the Model for End-Stage Liver Disease (MELD) was introduced for patients undergoing transjugular intrahepatic portosystemic shunt. It is currently used to predict survival in patients awaiting liver transplantation [3,4]. The MELD seems to be superior to the Child-Pugh score in prioritizing potential liver recipients according to mortality risk [5].…”