Comparison of General and Liver-Specific Prognostic Scores in Their Ability to Predict Mortality in Cirrhotic Patients Admitted to the Intensive Care Unit

Abstract

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.

Association and prediction of red blood cell distribution width to albumin ratio in all-cause mortality of acute kidney injury in critically ill patients

“…The SOFA score aims to quantitatively assess organ dysfunction over time, and the association between the quantification of the SOFA score and mortality is inevitable (46). Many studies have reported the predictive value of the SOFA score for the risk of mortality in critically ill patients (47)(48)(49). SAPSII scoring system contains age, physiological variables, and several complications, which can estimate the death risk of critically ill patients (50,51).…”

Association between white blood cell‐to‐haemoglobin ratio and 30 day mortality in heart failure in intensive care unit

“…21 Several studies have found that SOFA score performs well in the prediction of mortality in ICU patients. [22][23][24] The SAPSII scoring system includes age, physiological variables, and several complications, which can estimate the risk of death in ICU patients. 25,26 SOFA score and SAPSII score have been used for assessing the prognosis of ICU patients; however, SOFA score presented lower accuracy and SAPSII score showed complex calculations.…”

“…SOFA score is used to quantitatively evaluate the organ dysfunction over time, and the correlation between the quantification of SOFA score and mortality is inevitable 21 . Several studies have found that SOFA score performs well in the prediction of mortality in ICU patients 22–24 . The SAPSII scoring system includes age, physiological variables, and several complications, which can estimate the risk of death in ICU patients 25,26 .…”

Performance of Sequential Organ Failure Assessment and Simplified Acute Physiology Score II for Post-Cardiac Surgery Patients in Intensive Care Unit

“…A previous systematic review showed that the SOFA model based on 24 h after ICU admission could be used to predict mortality ( 19 ). Other types of patients were also effectively evaluated by SOFA score, including post-cardiac arrest syndrome ( 20 ), people requiring extracorporeal cardiopulmonary resuscitation ( 21 ), critically ill cirrhotic patients with acute decompensation ( 22 ), patients with acute respiratory failure in intensive care unit ( 23 ), contemporary cardiac intensive care unit population ( 24 ), critically ill elderly patients with acute infective endocarditis ( 25 ), extracorporeal membrane oxygenation (ECMO)-treated acute myocardial infarction (AMI) patients ( 26 )—some of above studies behaved even well. In the cardiac surgery population, the previous literature stated that SOFA score had good discriminative power for hospital mortality ( 27 ); the same observation was also confirmed in Ceriani et al's research ( 28 ).…”