The outcome of critical illness in decompensated alcoholic liver cirrhosis

Abstract

APACHE II, SAPS II, and SOFA were better at predicting mortality than the Child-Pugh score. With three or more organ failures, the ICU mortality was > 90%. APACHE II > 30, SAPS II > 60, and SOFA at day 1 > 12 were all associated with a mortality of > 90%. Referral criteria of patients suffering from decompensated alcoholic liver disease should be revised.

Prognosis of cirrhotic patients admitted to intensive care unit: a meta-analysis

“…Nine authors (ten studies) could not be contacted [15, 24–27] or did not answer [16, 20, 28–30]; three authors (five studies) agreed to participate but did not return the questionnaire [13, 17, 31–33]; two authors had no longer access to the database [9, 34]. Finally, we received 11 answers, covering 13 studies (2523 patients, Table 1; Additional file 1: Figure S1) [2, 3, 5–8, 10, 35–40].…”

A modified prognostic score for critically ill patients with cirrhosis: An observational study

“…In several recent studies, CLIF-SOFA had favorable performance (usually AUROCs > 0.8) and proved to be a strong predictor of mortality in patients with cirrhosis. 8,27,28 There is overlap between the components of MSCIC and CLIF-SOFA: HE, vasopressor use, serum bilirubin, and PT. Nevertheless, the MSCIC is more convenient and economical to use than that of CLIF-SOFA; this is because these easily measurable parameters are calculated in a qualitative approach in the MSCIC.…”

“…3,4 However, the mortality of patients with cirrhosis in the ICU remains high, varying from 34.7% to 90%. [5][6][7][8] The therapeutic effectiveness of life support is currently disputed. There has been growing interest in critically ill patients with cirrhosis due to the increased use of novel therapies.…”

The Liver in Critical Illness

“…The Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score (SAPS II), and Simplified Organ Failure Assessment (SOFA) have been shown to be superior at predicting outcome compared with the liver-specific Child-Pugh score. 15 Universally, the presence of 3 or more organ failures in patients with cirrhosis correlated with ICU mortality of greater than 90%. 15 The Model for End-Stage Liver Disease (MELD) score was originally designed to estimate survival in patients undergoing transjugular intrahepatic portosystemic shunting (TIPS).…”

“…14 Mortality among patients with underlying cirrhosis and acutely decompensated acute disease requiring organ support in an intensive care unit (ICU) ranges from 50% to nearly 100%. 15 Accordingly, ICU-specific scoring systems have been evaluated for their accuracy in this patient population. The Acute Physiology and Chronic Health Evaluation II (APACHE II), Simplified Acute Physiology Score (SAPS II), and Simplified Organ Failure Assessment (SOFA) have been shown to be superior at predicting outcome compared with the liver-specific Child-Pugh score.…”