Comparison of the predictive value of scoring systems on the prognosis of cirrhotic patients with suspected infection

Abstract

Cirrhotic patients with infection are prone to develop sepsis or even septic shock rendering poorer prognosis. However, few methods are available to predict the prognosis of cirrhotic patients with infection although there are some scoring systems can be used to predict general patients with cirrhosis. Therefore, we aimed to explore the predictive value of scoring systems in determining the outcome of critically ill cirrhotic patients with suspected infection.This was a retrospective cohort study based on a single-center database. The prognostic accuracy of the systemic inflammatory response syndrome (SIRS) criteria, quick Sequential Organ Failure Assessment (qSOFA), chronic liver failure (CLIF)-SOFA, quick CLIF-SOFA (qCLIF-SOFA), CLIF-consortium organ failure (CLIF-C OF), Model for End-Stage Liver Disease (MELD), and Simplified Acute Physiology Score (SAPS) II were compared by using area under the receiver operating characteristic (AUROC) curve and net benefit with decision curve analysis. The primary endpoint was in-hospital mortality while the secondary endpoints were duration of hospital and intensive care unit (ICU) stay and ICU mortality.A total of 1438 cirrhotic patients with suspected infection were included in the study. Nearly half the patients (50.2%) were admitted to the ICU due to hepatic encephalopathy and the overall in-hospital mortality was 32.0%. Hospital and ICU mortality increased as the score of each scoring system increased (P < .05 for all trends). The AUROC of CLIF-SOFA (AUROC, 0.742; 95% confidence interval, CI, 0.714–0.770), CLIF-C OF (AUROC, 0.741; 95% CI, 0.713–0.769), and SAPS II (AUROC, 0.759; 95% CI, 0.733–0.786) were significantly higher than SIRS criteria (AUROC, 0.618; 95% CI, 0.590–0.647), qSOFA (AUROC, 0.612; 95% CI, 0.584–0.640), MELD (AUROC, 0.632; 95% CI, 0.601–0.662), or qCLIF-SOFA (AUROC, 0.680; 95% CI, 0.650–0.710) (P < .05 for all). In the decision curve analysis, the net benefit of implementing CLIF-SOFA and CLIF-C OF to predict the prognosis of cirrhotic patients with suspected infection were higher compared with SIRS, qSOFA, MELD, or qCLIF-SOFA.CLIF-SOFA and CLIF-C OF scores, as well as SAPS II were better tools than SIRS, qSOFA, MELD, or qCLIF-SOFA to evaluate the prognosis of critically ill cirrhotic patients with suspected infection.

Global epidemiological burden of fungal infections in cirrhosis patients: A systematic review with meta‐analysis

“…Seventeen studies examined for multiple FIs; 21 studies examined specific FIs (pulmonary IFI, SFP, etc). The studies emanated from the Europe (n = 18) , 26,28,33,[35][36][37]39,[41][42][43]45,[47][48][49]51,53,59,60 Asia (n = 10), 27,[30][31][32]38,44,52,54,56,57 North America (n = 7) 6,25,29,34,46,55,58 or Africa (n = 2), 40,50 and one was a global study. 61…”

“…The denominator among the studies was all-cirrhosis (any aetiology or severity) in 28 studies 6,[25][26][27]29,33,34,[37][38][39][40][41][42][43][44][45][46][47][48]50,51,[53][54][55][58][59][60][61] or ACLF in 10 studies. 28,[30][31][32]35,36,49,52,56,57 The included patients were admitted in ICU (11 studies) 28,32,33,37,40,41,43,55,56,59,60 or in the hospital (area not specified; 27 studies). 6,25-27,29-31,34-36,38,39,42,4 4-54,57,58,61 The sample population (31 984 patients) had a median age of 56...…”

“…Proven IFIs were reported in 1118 out of 21 230 patients (29 studies) . 6,[26][27][28][29]31,33,[35][36][37][39][40][41][42][43][44][45][46][48][49][50][51][52][53][54][55][56]58,60 IC was reported in 847 out of 16 070 patients (23 studies), 6,25,26,28,29,31,33,35,36,[39][40][41]43,45,46,48,49,[51][52][53][54][55][56] IA in 189 out of 12 577 patien...…”

Update on diagnosis and management of sepsis in cirrhosis: Current advances

“…In a more recent study, Augustinho et al[ 61 ] showed that in patients with cirrhosis hospitalized for bacterial infections, admission qSOFA was an independent predictor of survival, and for those classified as high risk for death by qSOFA, only the CLIF-SOFA predicted prognosis independently, and Sepsis-3 criteria did not play a major role in predicting risk or stratifying patients. Lan et al[ 62 ] in a large retrospective cohort found that CLIF-SOFA and CLIF-organ failure scores were better tools that qSOFA, MELD, or qCLIF-SOFA in the evaluation of prognosis of critically ill patients with cirrhosis with suspected infections.…”

Relationship Between Etiology of Cirrhosis and Survival Among Patients Hospitalized in Intensive Care Units

“…31 In our study, the predictive value for qSOFA in identifying sepsis among patients with cirrhosis was only slightly inferior to that of SIRS (AUROC, 0.60 vs 0.64, respectively), and comparable to what has previously been reported in the literature. 32 In addition, the predictive value of qSOFA for in-hospital mortality (AUROC, 0.71) was similarly inferior to what has previously been reported in the literature for the general population (AUROC, 0.84). 33 Our study findings suggest limited clinical utility and applicablity of qSOFA among patients with cirrhosis and further emphasize the need for better screening tools for sepsis in critically ill patients with cirrhosis.…”