Comparison of the severity of illness scoring systems for critically ill cirrhotic patients with renal failure

Yc, Chen; Mh, Tsai; Yp, Ho; Cw, Hsu; Lin, Hui; Jt, Fang; Cc, Huang; Pc, Chen

doi:10.5414/cnp61111

Cited by 60 publications

(64 citation statements)

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“…For example, patients with cirrhosis admitted to the intensive care units with Cr > 1.5 mg/dL (> 132.6 mmol/L) had a poorer prognosis compared to those with Cr within the normal range. 7 Similarly, we showed that ARF (defined as Cr Ն 3.5 mg/dL [Ն 309.4 mmol/L], oliguria, and/or presence of HRS 8 or need for hemofiltration) was also significantly associated with poor outcome in critically ill patients with cirrhosis. 9 However, it is known that Cr is not an accurate index of glomerular filtration rate (GFR) (i.e.…”

Section: Introductionmentioning

confidence: 73%

“…Cr Ն 3.5 mg/dL [Ն 309.4 mmol/L] or oliguria [< 500 mL/day]), or the presence of HRS or need for hemofiltration. Although in contrast to the two previous studies 7,29 (from the same centre), we used a combination of Cr and diuresis to define ARF, neither our study, 9 nor these previous ones 7,29 evaluated the impact of different degrees of renal dysfunction (from normal kidney function to complete renal failure) on mortality.…”

Section: Discussionmentioning

confidence: 95%

“…In addition, these few studies defined ARF using different thresholds of Cr. For example, Chen et al 7 evaluated cirrhotic patients considering ARF as the presence of Cr Ն 1.5 mg/dL (Ն 132.6 mmol/L) ( Table 7); ARF on admission was associated with a high ICU mortality rate (86.6%). Similarly, Fang et al 29 from the same centre, evaluated 111 different cirrhotics with renal dysfunction.…”

Section: Discussionmentioning

confidence: 99%

“…In addition, the patients with mild ARF (RIFLE score 1 or 2) had significantly lower mortality rates, compared to the patients with severe ARF (75% vs 87%, P = 0.05). Finally, a higher RIFLE score was significantly associated with higher MELD and SOFA scores (for example the patients with RIFLE score 0, 1, 2 and 3 had median SOFA scores 9 [0-15], 11.5 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19], 13 [6][7][8][9][10][11][12][13][14][15][16][17][18] and 14 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21], respectively [P < 0.001]). The v...…”

Section: Mortalitymentioning

confidence: 99%

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RIFLE classification as predictive factor of mortality in patients with cirrhosis admitted to intensive care unit

Cholongitas

Calvaruso

Senzolo

et al. 2009

J of Gastro and Hepatol

102

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Background and Aim: To evaluate the association of the Risk, Injury, Failure, Loss and End-stage renal failure (RIFLE) score on mortality in patients with decompensated cirrhosis admitted to intensive care unit (ICU). Methods: A cohort of 412 patients with cirrhosis consecutively admitted to ICU was classified according to the RIFLE score. Multivariable logistic regression analysis was used to evaluate the factors associated with mortality. Liver-specific, Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) and RIFLE scores on admission, were compared by receiver-operator characteristic curves. Results: The overall mortality during ICU stay or within 6 weeks after discharge from ICU was 61.2%, but decreased over time (76% during first interval, 1989-1992 vs 50% during the last, 2005-2006, P < 0.001). Multivariate analysis showed that RIFLE score (odds ratio: 2.1, P < 0.001) was an independent factor significantly associated with mortality. Although SOFA had the best discrimination (area under receiver-operator characteristic curve = 0.84), and the APACHE II had the best calibration, the RIFLE score had the best sensitivity (90%) to predict death in patients during follow up. Conclusions: RIFLE score was significantly associated with mortality, confirming the importance of renal failure in this large cohort of patients with cirrhosis admitted to ICU, but it is less useful than other scores.

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Section: Introductionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

Section: Mortalitymentioning

confidence: 99%

See 2 more Smart Citations

RIFLE classification as predictive factor of mortality in patients with cirrhosis admitted to intensive care unit

Cholongitas

Calvaruso

Senzolo

et al. 2009

J of Gastro and Hepatol

102

View full text Add to dashboard Cite

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“…Previous data have combined patients with sepsis, encephalopathy and variable proportion of variceal bleeders of 26-66%. 19,20,[22][23][24][25][35][36][37][38][39][40][41][42][43] ICU and HM rates in our cohort were 28% and 39%, respectively compared to 36-39% and 44-74%, respectively in a recent review of all cirrhotics admitted to ICU. 20 This may be attributed to improved prognosis of cirrhotic patients admitted to ICU with AVH.…”

Section: Discussionmentioning

confidence: 99%

Comparison of scoring systems and outcome of patients admitted to a liver intensive care unit of a tertiary referral centre with severe variceal bleeding

Al-Freah

Gera

Martini

et al. 2014

Aliment Pharmacol Ther

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Summary Background Acute variceal haemorrhage (AVH) is associated with significant mortality. Aims To determine outcome and factors associated with hospital mortality (HM) in patients with AVH admitted to intensive care unit (ICU) and to compare outcomes of patients requiring transfer to a tertiary ICU (transfer group, TG) to a local in‐patient group (LG). Methods A retrospective study of all adult patients (N = 177) admitted to ICU with AVH from 2000–2008 was performed. Results Median age was 48 years (16–80). Male represented 58%. Median MELD score was 16 (6–39), SOFA score was 8 (6–11). HM was higher in patients who had severe liver disease or critical illness measured by MELD, SOFA, APACHE II scores and number of failed organs (NFO), P < 0.05. Patients with day‐1 lactate ≥ 2 mmol/L had increased HM (P < 0.001). MELD score performed as well as APACHE II, SOFA and NFO (P < 0.001) in predicting HM (AUROC = 0.84, 0.81, 0.79 and 0.82, respectively P > 0.05 for pair wise comparisons). Re‐bleeding was associated with increased HM (56.9% vs. 31.6%, P = 0.002). The TG (n = 124) had less severe liver disease and critical illness and consequently had lower HM than local patients (32% vs. 57%, P = 0.002). TG patients with ≥2 endoscopies prior to transfer had increased 6‐week mortality (P = 0.03). Time from bleeding to transfer ≥3 days was associated with re‐bleeding (OR = 2.290, P = 0.043). Conclusions MELD score was comparable to ICU prognostic models in predicting mortality. Blood lactate was also predictive of hospital mortality. Delays in referrals and repeated endoscopy were associated with increased re‐bleeding and mortality in this group.

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Association of AKI With mortality and complications in hospitalized patients with cirrhosis

et al. 2012

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Acute kidney injury (AKI) is a common and devastating complication in patients with cirrhosis. However, the definitions of AKI employed in studies involving patients with cirrhosis have not been standardized, lack sensitivity and are often limited to narrow clinical settings. We conducted a multi-center, prospective observational cohort study of patients with cirrhosis and AKI, drawn from multiple hospital wards, utilizing the modern acute kidney injury network (AKIN) definition and assessed for the association between AKI severity and progression with inhospital mortality. Of the 192 patients that were enrolled and included in the study, 85 (44%) patients progressed to a higher AKIN stage after initially fulfilling AKI criteria. Patients achieved a peak severity of AKIN stage 1, 26%, stage 2, 24%, and stage 3, 49%. The incidence of mortality, general medical events (bacteremia, pneumonia, urinary tract infection) and cirrhosis specific complications (ascites, encephalopathy, spontaneous bacterial peritonitis) increased with severity of AKI. Progression was significantly more common and peak AKI stage higher in non-survivors than survivors (p < 0.0001). After adjusting for baseline renal function, demographics and critical hospital and cirrhosis associated variables, progression of AKI was independently associated with mortality (adjusted OR = 3.8, 95% CI 1.3–11.1). Conclusion AKI, as defined by AKIN criteria, in patients with cirrhosis is frequently progressive and severe and is independently associated with mortality in a stage-dependent fashion. Methods for earlier diagnosis of AKI and its progression may result in improved outcomes by facilitating targeted and timely treatment of AKI.

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Comparison of the severity of illness scoring systems for critically ill cirrhotic patients with renal failure

Cited by 60 publications

References 0 publications

RIFLE classification as predictive factor of mortality in patients with cirrhosis admitted to intensive care unit

RIFLE classification as predictive factor of mortality in patients with cirrhosis admitted to intensive care unit

Comparison of scoring systems and outcome of patients admitted to a liver intensive care unit of a tertiary referral centre with severe variceal bleeding

Association of AKI With mortality and complications in hospitalized patients with cirrhosis

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