Retrospective evaluation of prognostic score performances in cirrhotic patients admitted to an intermediate care unit

Dupont, B.; Delvincourt, Maxime; Kone, Mamadou; Cheyron, Damien du; Ollivier-Hourmand, Isabelle; Piquet, Marie-Astrid; Terzi, Nicolas; Dao, Thông

doi:10.1016/j.dld.2015.04.001

Cited by 18 publications

(14 citation statements)

References 27 publications

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“…Thus, it is not surprisingly that the SAPS 3 showed superior accuracy in mortality prediction for liver failure and cirrhosis than the SAPS 2, in our cohort. Even though Dupont et al reported controversial findings in cirrhotic patients, our data are in line with a recent study by Alegre et al that also attested superior test performance for the SAPS 3 compared to the SAPS 2 in patients with liver cirrhosis [21, 34]. Furthermore, differences between present study results and previous research are emphasized in septic patients; here, we observed the most pronounced underestimation of mortality risk using either score.…”

Section: Discussionsupporting

confidence: 90%

“…Taken together, this study aimed to analyze and compare performance of the SAPS 2 vs. the SAPS 3 in patients with internal disorders—who were admitted to an ImCU at a German university hospital´s transplant center—in order to improve the quality of local care evaluation and management. In addition, our data should be cross-interpreted with results from previous studies that evaluated the performance of both scores in non-surgical ImCU patients [18–21].…”

Section: Introductionmentioning

confidence: 95%

“…To date, in contrast to ICUs [2–4, 6, 7, 10–17], reports on routine application of mortality prediction scores in intermediate care units (ImCUs) are scarce [18–21]. Although such scores are considered important in decision-making processes in critical care, they are not yet standardly integrated in routine algorithms (e.g., via the hospital information system) in German ImCUs.…”

Section: Introductionmentioning

confidence: 99%

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The predictive performance of SAPS 2 and SAPS 3 in an intermediate care unit for internal medicine at a German university transplant center; A retrospective analysis

Jahn

Rekowski²,

Gerken

et al. 2019

PLoS ONE

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ObjectiveTo analyze and compare the performance of the Simplified-Acute-Physiology-Score (SAPS) 2 and SAPS 3 among intermediate care patients with internal disorders.Materials and methodsWe conducted a retrospective single-center analysis in patients (n = 305) admitted to an intermediate-care-unit (ImCU) for internal medicine at the University Hospital Essen, Germany. We employed and compared the SAPS 2 vs. the SAPS 3 scoring system for the assessment of disease severity and prediction of mortality rates among patients admitted to the ImCU within an 18-month period. Both scores, which utilize parameters recorded at admission to the intensive-care-unit (ICU), represent the most widely applied scoring systems in European intensive care medicine. The area-under-the-receiver-operating-characteristic-curve (AUROC) was used to evaluate the SAPS 2 and SAPS 3 discrimination performance. Ultimately, standardized-mortality-ratios (SMRs) were calculated alongside their respective 95%-confidence-intervals (95% CI) in order to determine the observed-to-expected death ratio and calibration belt plots were generated to evaluate the SAPS 2 and SAPS 3 calibration performance.ResultsBoth scores provided acceptable discrimination performance, i.e., the AUROC was 0.71 (95% CI, 0.65–0.77) for SAPS 2 and 0.77 (95% CI, 0.72–0.82) for SAPS 3. Against the observed in-hospital mortality of 30.2%, SAPS 2 showed a weak performance with a predicted mortality of 17.4% and a SMR of 1.74 (95% CI, 1.38–2.09), especially in association with liver diseases and/or sepsis. SAPS 3 performed accurately, resulting in a predicted mortality of 29.9% and a SMR of 1.01 (95% CI, 0.8–1.21). Based on Calibration belt plots, SAPS 2 showed a poor calibration-performance especially in patients with low mortality risk (P<0.001), while SAPS 3 exhibited a highly accurate calibration performance (P = 0.906) across all risk levels.ConclusionsIn our study, the SAPS 3 exhibited high accuracy in prediction of mortality in ImCU patients with internal disorders. In contrast, the SAPS 2 underestimated mortality particularly in patients with liver diseases and sepsis.

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Section: Discussionsupporting

confidence: 90%

Section: Introductionmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

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The predictive performance of SAPS 2 and SAPS 3 in an intermediate care unit for internal medicine at a German university transplant center; A retrospective analysis

Jahn

Rekowski²,

Gerken

et al. 2019

PLoS ONE

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“…We also found that bleeding was the most common precipitating event, seen in 29.8% of our patients. Dominguez et al [20] had similar rates of bleeding, while Dupont et al [21] reported higher bleeding rates (47%). Furthermore, higher occurrence of bleeding as the precipitating event to ACLF was seen in patients with diagnosed hepatorenal syndrome [22].…”

Section: Prognostic Scoresmentioning

confidence: 93%

Evaluation of treatment outcome in patients with acute-on-chronic liver failure using clinical scores

Milovanović

Lalosevic²,

Dragašević

et al. 2020

Srp Arh Celok Lek

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Introduction/Objective Due to a very high mortality risk, acute-on-chronic liver failure (ACLF) patients require early identification and intensive treatment. Precise prediction is crucial for determining the urgency degree and therapy appropriateness, considering high mortality and multitude of clinical resources. The aim of our study was to determine the exact cutoff values of various prognostic scores in the prediction of morality of ACLF. Methods This prospective study includes chronic liver disease (CLD) patients, admitted due to decompensation, that were subsequently diagnosed with ACLF at the Emergency unit. All patients were evaluated based on various prognostic scores, including Child-Pugh, MELD Na, MELD, SOFA, APACHE II, and CLIF C, which were calculated on admission. Results Alcoholic liver disease (ALD) was the most common underlying CLD cause (77.9%), followed by viral (8.6%), autoimmune (7.7%), and other causes (5.8%). A total of 37.5% of the patients died at the end of the first month of treatment. Average values of Child-Pugh, MELD Na, MELD, SOFA, APACHE II, and CLIF C scores were significantly higher in patients who died compared to survivors (p < 0.05). CLIF C score showed the best performance with a cutoff value of 50.5, with a sensitivity of 94.9% and specificity of 40%. Conclusion ACLF remains a condition with a high short-term mortality. Of all of the scores examined in our study, CLIF C proved to be the best scoring system for predicting short term and end of treatment mortality in patients with ACLF.

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“…Last, increased humanistic care in HDUs may help reduce the incidence of post-intensive care syndrome in patients who are otherwise at risk [9]. However, the role of HDUs in the management of patients with severe liver disease (SLD) has received limited attention [10]. The purpose of this letter is to describe the first HDU for SLD in China and showcase its performance using an example case.…”

mentioning

confidence: 99%

High-dependency units play a key role in the treatment of a Chinese military patient who developed liver failure while abroad

Liu

et al. 2019

Military Med Res

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High-dependency units (HDUs) provide high-level care to patients who suffer from single organ failure, with the exception of respiratory failure requiring mechanical ventilation; HDUs serve as an intermediary between general wards and Intensive Care Units. Due to military and civilian needs, our hospital has established a unique HDU for patients with liver disease in China. A Chinese military officer in the United Nations Peacekeeping Forces in South Sudan was transferred to our HDU for liver failure treatment in 2018. The patient’s disease status, nutrition, sleep habits, and psychological behaviour were monitored on different scales. The patient was provided with vascular monitoring, telemetry, pulse oximetry, drug treatment, nutritional support, sleep intervention, psychological intervention, and humanistic care by a multidisciplinary treatment team. After treatment, the patient recovered and avoided liver transplantation. Based on the experience with this HDU, this new model may create an efficient treatment process for military and civilian patients with severe liver disease at home or abroad.

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Retrospective evaluation of prognostic score performances in cirrhotic patients admitted to an intermediate care unit

Cited by 18 publications

References 27 publications

The predictive performance of SAPS 2 and SAPS 3 in an intermediate care unit for internal medicine at a German university transplant center; A retrospective analysis

The predictive performance of SAPS 2 and SAPS 3 in an intermediate care unit for internal medicine at a German university transplant center; A retrospective analysis

Evaluation of treatment outcome in patients with acute-on-chronic liver failure using clinical scores

High-dependency units play a key role in the treatment of a Chinese military patient who developed liver failure while abroad

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