A comparison of Child-Pugh, APACHE II and APACHE III scoring systems in predicting hospital mortality of patients with liver cirrhosis

Chatzicostas, Constantinos; Roussomoustakaki, Maria; Notas, George; Vlachonikolis, Ioannis G.; Samonakis, D; Romanos, John; Vardas, Emmanouel

doi:10.1186/1471-230x-3-7

Cited by 23 publications

(14 citation statements)

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“…less sick patients. Indeed, although APACHE II works well for severely ill cirrhotic patients admitted to ICUs (13,17,29,(36)(37)(38), this is not the case when its predictive value is assessed in a population of cirrhotic patients with mortality rate of only 11.5% (41). Thus, our results are somewhat surprising, because the mortality rate in our sample was only 9.7% and nevertheless the scores showed an excellent performance.…”

Section: Discussioncontrasting

confidence: 51%

“…Patients admitted for less than one day were excluded from the study. For the purposes of this study, each admission was considered a separate patient, as previously reported (41).…”

Section: Patient Informationmentioning

confidence: 99%

“…The clinical diagnosis of cirrhosis was made by a history of portal hypertension excluding other etiology, evidence of esophageal varices confirmed by endoscopy, impaired liver function tests, impaired clotting parameters and ultrasonographic or computer tomographic criteria (41)(42)(43)(44).…”

Section: Patient Informationmentioning

confidence: 99%

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Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

Freire

Romãozinho²,

Amaro³

et al. 2011

Rev. esp. enferm. dig.

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Aim: to assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), Model for End-stage Liver Disease (MELD) and ChildPugh-Turcotte (CPT) in predicting GICU mortality in cirrhotic patients.Methods: the study involved 124 consecutive cirrhotic admissions to a GICU. Clinical data, prognostic scores and mortality were recorded. Discrimination was evaluated with area under receiver operating characteristic curves (AUC). Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test.Results: GICU mortality was 9.7%. Mean APACHE II, SAPS II, SOFA, MELD and CPT scores for survivors (13.6, 25.4, 3.5, 18.0 and 8.6, respectively) were found to be significantly lower than those of non-survivors (22.0, 47.5, 10.1, 30.7 and 12.5, respectively) (p < 0.001). All the prognostic systems showed good discrimination, with AUC = 0.860, 0.911, 0.868, 0.897 and 0.914 for APACHE II, SAPS II, SOFA, MELD and CPT, respectively. Similarly, APACHE II, SAPS II, SOFA, MELD and CPT scores achieved good calibration, with p = 0.146, 0.120, 0.686, 0.267 and 0.120, respectively. The overall correctness of prediction was 81.9%, 86.1%, 93.3%, 90.7% and 87.7% for the APA-CHE II, SAPS II, SOFA, MELD and CPT scores, respectively.Conclusions: in cirrhotics admitted to a GICU, all the tested scores have good prognostic accuracy, with SOFA and MELD showing the greatest overall correctness of prediction. INTRODUCTIONPrognostic models are used for comparison and quality assessment of different Intensive Care Units (ICUs) and within the same ICU over time, for audit and clinical research, for evaluating therapeutic effectiveness and for guiding discussions between clinicians and families (1-6).The incidence of liver cirrhosis is increasing exponentially and cirrhotic patients admitted to ICUs have high mortality rates and a high rate of consumption of resources (7-18). Furthermore, a significant percentage (36.7%) of the total cost of ICU care for cirrhotic patients is spent on those who do not survive (11,16,19). Additionally, it must be borne in mind that ICUs are a very limited health resource (10,11,18). Thus, predictive models could be very important decision-making tools in this setting.Two types of prognostic scores can be used in cirrhotics admitted to ICUs: general prognostic models and disease-specific models. The general prognostic models include two main categories: firstly, those evaluating severity of illness, namely the Acute Physiology and Chronic Health Evaluation (APACHE) II (20) and Simplified Acute Physiology Score (SAPS) II (21); secondly, models quantifying organ dysfunction and failure, of which the most widely-used is the Sequential Organ Failure Assessment (SOFA) (22,23 Vol. 103. N.° 4, pp. 177-183, 2011 Received: 04-10-10. Accepted: 02-12-10.

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Section: Discussioncontrasting

confidence: 51%

“…Patients admitted for less than one day were excluded from the study. For the purposes of this study, each admission was considered a separate patient, as previously reported (41).…”

Section: Patient Informationmentioning

confidence: 99%

See 1 more Smart Citation

Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

Freire

Romãozinho²,

Amaro³

et al. 2011

Rev. esp. enferm. dig.

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“…Two categories of prognostic models are commonly used: first, those evaluating the severity of illness: Acute Physiology and Chronic Health Evaluation (APACHE) II and III, Simplified Acute Physiology Score (SAPS) II, and Mortality Prediction Model II, which are most commonly used [70,96], and second, models quantifying organ dysfunction and failure: Logistic Organ Dysfunction System, Multiple Organ Dysfunction Score, Organ System Failure (OSF), and Sequential Organ Failure Assessment (SOFA) [97]. The MELD was originally created and validated in patients in whom an acute reversible complication like bacterial infection or azotemia was not present and not designed to predict mortality in an ICU setting [98].…”

Section: Prognostic Scores For Aclfmentioning

confidence: 99%

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

et al. 2014

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The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, ''APASL ACLF Research Consortium (AARC),'' was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the

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“…Upon presentation, providers must first classify an episode of pancreatitis as mild versus severe based on a validated scoring system such as Balthazar, APACHE, and Ranson's scores [40,41]. In mild acute pancreatitis, starting a liquid or soft diet as soon as pain is controlled has been shown to reduce length of stay and may accelerate recovery [42].…”

Section: Acute Pancreatitismentioning

confidence: 99%

Development of quality measures for monitoring and improving care in gastroenterology

Germansky

Leffler

2011

Best Practice & Research Clinical Gastroenterology

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A comparison of Child-Pugh, APACHE II and APACHE III scoring systems in predicting hospital mortality of patients with liver cirrhosis

Abstract: Background: The aim of this study was to assess the prognostic accuracy of Child-Pugh and APACHE II and III scoring systems in predicting short-term, hospital mortality of patients with liver cirrhosis.

Cited by 23 publications

References 49 publications

Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Development of quality measures for monitoring and improving care in gastroenterology

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