Introduction. Acute Physiology and Chronic Health Evaluation (APACHE) II and III and Sequential Organ Failure Assessment (SOFA) are prognostic scores commonly used in the intensive care unit (ICU). Their accuracy in predicting mortality has not been adequately evaluated in comparison to prognostic scores commonly used in critically ill cirrhotic patients with acute decompensation (AD) or acute-on-chronic liver failure (ACLF). Aims. This study was conducted to evaluate the performance of prognostic scores, including APACHE II, SOFA, Chronic Liver Failure Consortium (CLIF-C) SOFA, Child–Turcotte–Pugh (CPS), Model for End-Stage Liver Disease (MELD), MELD-Na, MELD to serum sodium ratio (MESO) index, CLIF-C organ failure (CLIF-C OF), CLIF-C ACLF, and CLIF-C AD scores, in predicting mortality of cirrhotic patients admitted to the ICU. Patients and Methods. A total of 382 patients (280 males, mean age 67.3 ± 10.6 years) with cirrhosis were retrospectively evaluated. All prognostic scores were calculated in the first 24 hours of ICU admission. Their ability to predict mortality was measured using the analysis of the area under the receiver operating characteristic curve (AUC). Results. Mortality was observed in 31% of the patients. Analysis of AUC revealed that CLIF-C OF (0.807) and CLIF-SOFA (0.776) had the best ability to predict mortality in all patients, but CLIF-C OF (0.749) had higher prognostic accuracy in patients with ACLF. CLIF-SOFA, SOFA, and CLIF-C AD had the highest AUC values in patients with AD, with no statistical difference ( p = 0.971 ). Conclusions. When compared to other general or liver-specific prognostic scores, CLIF-C OF, CLIF-SOFA, SOFA, and CLIF-C AD have good accuracy to predict mortality in critically ill patients with cirrhosis and patients with AD. According to the clinical scenario, different scores should be used to provide prognosis to patients with cirrhosis in the ICU.

We report a case of a female patient, 48 years, with hematuria and weight loss 7 kg in 3 months. In CT, mass lesion in the right adrenal topography, heterogeneous partially defined contours hypervascularized and about 11.8 Â 10.9 Â 6.4, with hepatic lesions with similar characteristics in segment VII VIII (9.7 Â 6.8 cm), II (1.7 cm), V (2.3 cm), VI (0.9 cm) . Underwent surgery being performed right hepatectomy, nephrectomy and adrenalectomy; nodulectomy in segment IVb and II; and biliodigestive shunt in Y Roux into the left hepatic duct. The histopathology was compatible with high histological grade leiomyosarcoma, multifocal, confirmed by immunohistochemistry.The primary hepatic sarcomas representing only 0.1%e 2% of hepatic cancer. Abdominal pain, weight loss, vomiting and jaundice are the common symptoms, while hepatomegaly and a palpable mass are frequently disclosed on physical examination. Most hepatic leiomyosarcoma are metastatic from other sites.CT findings have been described as a large, well-defined, heterogeneous hypodensity mass with internal and peripheral enhancement.The standard of care has not been defined; however, surgical resection followed by adjuvant chemotherapy is being widely followed in an empirical manner.To improve our understanding and the results for patients are needed more data to analyze and understand the results of different therapies.

Nineteen patients underwent total isolated caudate lobe resection, seventeen patients underwent Spiegel lobe resection, four patients underwent caudate process resection, and three patients underwent paracaval portion resection. The mean operative time was 222 AE 127.7 minutes and the mean estimated intraoperative blood loss was 523.6 AE 141.6 mL. There was one perioperative death, and postoperative complication rate was 16.3% (7/43). Conclusion: ICLR is difficult technically but proper surgical approach in patient with sufficient liver function reserve ensures that ICLR is safe and curative surgery.

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