The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit

Emerson, Philip; McPeake, Joanne; O’Neill, Anna; Gilmour, Harper; Forrest, Ewan; Puxty, Alex; Kinsella, John; Shaw, Martin

doi:10.1016/j.jcrc.2014.06.027

Cited by 21 publications

(41 citation statements)

References 38 publications

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“…Liver disease is the third most common cause of premature death in the United Kingdom (UK) [1], and patients with liver cirrhosis now comprise between 2.6 and 15% of admissions to intensive care units (ICUs) in the UK [2–5]. Though survival in this patient group has historically been very poor, with reported hospital mortality as high as 89% [6–8], it has recently demonstrated that short-term survival is now improving [9–11].…”

Section: Introductionmentioning

confidence: 99%

“…Whilst this population has been well-studied with respect to short-term outcome [3–5, 10–14], relatively few studies have reported on long-term outcomes of critically ill cirrhotic patients. A 2006 study from a Scottish transplant centre demonstrated 12-month mortality of 81% in ICU admissions with decompensated alcoholic cirrhosis [4]; other non-UK transplant centres have reported 6-month mortality of between 62 and 71% [15–17].…”

Section: Introductionmentioning

confidence: 99%

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Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

Warren

Soulsby

Puxty

et al. 2017

Ann. Intensive Care

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ObjectivesThe prevalence of liver cirrhosis is increasing, and many patients have acute conditions requiring consideration of intensive care. This study aims to: (a) report the outcome at 12 months of patients with cirrhosis admitted to ICU, (b) identify factors predictive of long-term mortality and (c) evaluate the ability of scoring systems to predict long-term outcome.DesignObservational cohort study.SettingGeneral adult critical care unit in a UK teaching hospital.PatientsEighty-four patients admitted to critical care between June 2012 and December 2013.Primary outcome measuresCumulative survival at ICU discharge, hospital discharge and 12 months.ResultsEighty-four patients with diagnosed cirrhosis were followed up at 12 months. Clinical variables collected at ICU admission were entered into a multivariate regression analysis for mortality and eight predetermined scoring systems calculated. Cumulative survival at ICU discharge, hospital discharge and 12 months was 64.8, 47.1 and 44.1%, respectively. Twelve months of cumulative survival in patients with Child–Pugh class A was 100%, class B was 50% and class C was 25% (log rank p = 0.002). Independent predictors of mortality at 12 months were lactate, bilirubin, PT ratio and age. The Child–Pugh + Lactate score was modified to produce an objective score comprising Albumin, Bilirubin and Clotting (PT ratio) added to serum lactate concentration in mmol L−1 (ABC + Lactate). This score was the best predictor of 12-month survival, with an AUC of 0.83. A proposed classification by ABC + Lactate score was highly significant (p = 0.001), with those in the highest class having ICU mortality of 75% and hospital and 12-month mortality of 93%.ConclusionsPatients with cirrhosis admitted to ICU have high initial mortality but low mortality after hospital discharge. Child–Pugh class at ICU admission predicts outcome at 12 months. The ABC + Lactate classification system may be useful in identifying critically ill cirrhotic patients with very high long-term mortality.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

Warren

Soulsby

Puxty

et al. 2017

Ann. Intensive Care

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“…26 Several studies have shown that besides hepatic failure, cardiovascular system dysfunction 27,28 , renal failure 21,29 , elevated lactate [30][31][32] , and ascites 32 were independent factors for mortality. Unlike the MELD score which focuses only on hepatic and renal function, ICU-specific prognosis scores also consider other organ system dysfunction ( Table 2).…”

Section: Meld Score As a Prognostic Predictor For Cirrhotic Patients mentioning

confidence: 99%

“…Most studies have shown that SOFA scores correlate with mortality better than MELD scores [31][32][33][34][35][36][37][38] , APACHE II scores 31,32,34,[38][39][40][41] , and SAPS II scores. 37 Das et al reported the presence of five non-hematologic organ failures in the SOFA score at the admission to the ICU was associated with 100% in-hospital mortality.…”

Section: Comparing Meld Score and Icu-specific Scores (Saps II Apachmentioning

confidence: 99%

The use of MELD scores in critically ill cirrhotic patients

Rassameehiran¹,

Woreta²

2016

SWRCCC

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The Model for End-Stage Liver Disease (MELD) was originally created to predict survival following transjugular intrahepatic portosystemic shunt and was subsequently found to accurately predict mortality in patients with end-stage liver disease. It has been used in the United States for liver allocation since 2002, and implementation of the MELD score resulted in a reduction in total number of deaths on the waitlist and a reduction in waiting time. Critically ill cirrhotic patients have an in-hospital mortality greater than 50%. Although the MELD score was also found to be an accurate predictor of in-ICU mortality and in-hospital mortality after ICU admission in critically ill cirrhotic patients, the Sequential Organ Failure Assessment (SOFA) score appears to perform better in many studies. The Chronic Liver Failure Consortium Acute-onChronic Liver Failure (CLIF-C ACLF) score was later developed by using specific cut-points for each organ failure score system in CLIF patients to predict mortality in patients with ACLF. Neither the MELD nor SOFA score independently predicts post-liver transplantation mortality in cirrhotic patients with extrahepatic organ failure and should not be use as a delisting criterion for these patients. More data are needed to determine the accuracy of the CLIF-C ACLF score in predicting post-liver transplantation outcomes. Prospective evaluation of critically ill cirrhotic patients is needed to optimize liver organ allocation.

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“…In previous research from a single centre, a novel prognostic scoring tool (the CTP þ L score), which modified the existing Child-Turcotte Pugh score by adding serum arterial Lactate concentration, was strongly associated with mortality. 1 This study aims to validate the use of the CTP þ L scoring tool for predicting ICU mortality in patients admitted to a general ICU with cirrhotic liver disease. This study will also explore the use of the Royal Free Hospital (RFH) scoring system in this cohort.…”

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confidence: 99%

Validation of a prognostic scoring system for critically ill patients with cirrhosis admitted to ICU

Campbell

McPeake

Shaw

et al. 2015

Journal of the Intensive Care Society

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ICU admissions due to cirrhotic liver disease are rising in the UK. Current prognostic scoring tools to predict ICU mortality have performed poorly in this group. In previous research from a single centre, a novel prognostic scoring tool (the CTP þ L score), which modified the existing Child-Turcotte Pugh score by adding serum arterial Lactate concentration, was strongly associated with mortality.1 This study aims to validate the use of the CTP þ L scoring tool for predicting ICU mortality in patients admitted to a general ICU with cirrhotic liver disease. This study will also explore the use of the Royal Free Hospital (RFH) scoring system in this cohort. 2 MethodsEighty-four patients admitted to the Glasgow Royal Infirmary ICU with cirrhosis were included. An additional cohort of 115 patients was obtained from two ICUs in London (St George's and St Thomas'). Liver-specific and general ICU scoring tools were calculated for both cohorts and compared using area under the receiver operating characteristic curves. Independent predictors of ICU mortality were identified by univariate analysis. ResultsWithin the Glasgow cohort, independent predictors of ICU mortality were identified as Lactate (p < 0.001), Bilirubin (p ¼ 0.0048), PaO 2 /FiO 2 ratio (p ¼ 0.032) and PT ratio (p ¼ 0.012). Within the London cohort, independent predictors of ICU mortality were Lactate (p < 0.001), PT ratio (p < 0.001), Bilirubin (p ¼ 0.027), PaO 2 /FiO 2 ratio (p ¼ 0.0011) and Ascites (p ¼ 0.023). Multivariate analysis identified Lactate and Bilirubin as the most significant predictors of ICU mortality in the Glasgow cohort, and Lactate and PT ratio in the London dataset. Based on area under the receiver operating characteristic curves, the CTP þ L and RFH scoring tools were the most predictive of ICU mortality in both cohorts. DiscussionThe CTP þ L and RFH scoring tools are validated prognostic scoring tools for predicting ICU mortality in patients admitted to a general ICU with cirrhotic liver disease. However, the CTP þ L can be calculated quickly and simply, in contrast to the RFH score which utilises a complex equation.

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The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit

Cited by 21 publications

References 38 publications

Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit

The use of MELD scores in critically ill cirrhotic patients

Validation of a prognostic scoring system for critically ill patients with cirrhosis admitted to ICU

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