Validation and analysis of prognostic scoring systems for critically ill patients with cirrhosis admitted to ICU

Campbell, John; McPeake, Joanne; Shaw, Martin; Puxty, Alex; Forrest, Ewan; Soulsby, Charlotte; Emerson, Philp; Thomson, Sarah; Rahman, Tony; Quasim, Tara; Kinsella, John

doi:10.1186/s13054-015-1070-y

Cited by 21 publications

(14 citation statements)

References 28 publications

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“…Whilst MELD did perform well on this cohort, it is limited by the lack of an easily accessible grading system to stratify patient into groups and hence identify patients with a high risk of mortality. Similarly, the RFH score, which has been validated for short-term outcome in both the specialist and general settings [11, 24], failed to perform as well in this long-term study. The Child–Pugh + Lactate score attempted to meet this need with the incorporation of a measure of acute illness correlated with poor short-term outcome [5].…”

Section: Discussionmentioning

confidence: 98%

“…However, ROC curve analysis alone is unlikely to provide a true measure of a score’s clinical usefulness [24, 31]. A classification system with mortality rates for each class is far easier for clinicians to interpret and apply at the bedside, which a score alone does not permit.…”

Section: Discussionmentioning

confidence: 99%

“…The Child–Pugh + Lactate score attempted to meet this need with the incorporation of a measure of acute illness correlated with poor short-term outcome [5]. However, this score remains limited as both the ascites and encephalopathy components are subjective and difficult to assess in the acute setting [24, 31]. Previous work from this centre has demonstrated that the omission of encephalopathy scores from both Child–Pugh and Child–Pugh + Lactate did not affect the short-term predictive value [24], and so it is perhaps unsurprising that the ABC + Lactate score, which removes these components, performed better in this study.…”

Section: Discussionmentioning

confidence: 99%

“…We have previously reported on the acute mortality of this population [24]. This unit is a 20-bed mixed surgical and medical critical care unit within a university hospital which does not provide liver transplant services.…”

Section: Methodsmentioning

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: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

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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“…Additionally, Campbell et al. studied a retrospective cohort of 84 critically ill patients with cirrhosis and demonstrated that lactate on admission to ICU was significantly associated with ICU mortality with an aOR of 1.89 . Finally, Edmark et al.…”

Section: Discussionmentioning

confidence: 99%

Lactate and number of organ failures predict intensive care unit mortality in patients with acute‐on‐chronic liver failure

Cardoso

Abraldes

et al. 2019

Liver International

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Background and Aims:Patients with acute-on-chronic liver failure (ACLF) have high mortality rates. Most prognostic scores were not developed for the intensive care unit (ICU) setting. We aimed to improve risk stratification for patients with ACLF in the ICU. Methods:A training set with 240 patients with cirrhosis and organ failures (Chronic was used to derive a prognostic model for ICU mortality. A validation set with 237 patients with cirrhosis and organ failures from Vancouver General Hospital (Canada) in 2000-2011 was used to evaluate its performance. Results: Amongst patients in the training set, ICU and hospital mortality rates were 39.2% and 54.6% respectively. Median lactate (4.4 vs 2.5 mmol/L) and number of organ failures (3 vs 2) on admission to ICU were associated with higher likelihood of ICU mortality (P < 0.001 for both). The lactate and organ failures predictive model (LacOF) was derived to predict ICU mortality: −2.420 + 0.072 × lactate + 0.569 × number of organ failures (area under-the-curve [AUC], 0.76). In the validation set, the LacOF model discriminative ability (AUC, 0.85) outperformed the CLIF-SOFA (AUC, 0.79), Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (AUC, 0.73), Model for End-stage Liver Disease score (AUC, 0.78) and Acute Physiology and Chronic Health Evaluation II scores (AUC, 0.74; P < 0.05 for all). The LacOF model calibration was good up to the 25% likelihood of ICU mortality. Conclusions:In patients with ACLF, lactate and number of organ failures on admission to ICU are useful to predict ICU mortality. This early prognostic evaluation may help to better stratify the risk of ICU mortality and thus optimize organ support strategies. K E Y W O R D Scirrhosis, critical care, death, prognosis

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MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis

et al. 2022

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Validation and analysis of prognostic scoring systems for critically ill patients with cirrhosis admitted to ICU

Cited by 21 publications

References 28 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

Lactate and number of organ failures predict intensive care unit mortality in patients with acute‐on‐chronic liver failure

MELD-Lactate Predicts Poor Outcome in Variceal Bleeding in Cirrhosis

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