Intensive care management of patients with liver disease: proceedings of a single-topic conference sponsored by the Brazilian Society of Hepatology

Bittencourt, Paulo Lisboa; Terra, Carlos; Parise, Edison Roberto; Farias, Alberto Queiróz; Arroyo, Vicente; Fernández, Javier; Maubouisson, Luiz Marcelo; Andrade, Guilherme Marques; Costa, Fernando Henrique da Silva; Codes, Liana; Andrade, Antonio; Matos, Ângelo Paggi; Torres, A.; Couto, Fernanda Bueno D’Elboux; Zyngier, Ivan

doi:10.1590/s0004-28032015000500004

Cited by 7 publications

(5 citation statements)

References 97 publications

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“…We have found that SOFA, CLIF-SOFA, and CLIF-COF scores had a better performance when compared to other general ICU and liver-specific scores, such as APACHE II, CCI, MELD, and its variants and CTP scores in the entire group of patients. SOFA score was previously associated with better prognostication, particularly when compared to MELD and CTP scores, for every patient with cirrhosis in several [9,12,[41][42][43][44] but not all publications [45]. Due to these findings, CLIF-C investigators adapted SOFA score to incorporate INR, instead of platelet count (CLIF-SOFA), to better evaluate liver dysfunction and organ failure (CLIF-C OF) in critically ill cirrhotic patients [26,27,31].…”

Section: Discussionmentioning

confidence: 99%

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

Silva

Codes

Rios

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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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.

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Section: Discussionmentioning

confidence: 99%

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

Silva

Codes

Rios

et al. 2021

Canadian Journal of Gastroenterology and Hepatology

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“…The clinical management of patients with HE requires a wide and rigorous differential screening for other causes of encephalopathy and identification of triggers for HE (table 2). Specific therapies for HE (table 3) are often initiated along with treatment of the triggering factors such as gastrointestinal bleeding, toxic medications, electrolyte disorders, and renal dysfunction (table 2) [55]. Cirrhotic patients with HE should have a daily protein intake of 1.2-1.5 g/kg body weight in order to prevent further sarcopenia and thus progress to cachexia.…”

Section: Hepatic Encephalopathymentioning

confidence: 99%

Intensive Care Therapy for Patients with Advanced Liver Diseases

Katsounas

Canbay

2018

Visc Med

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Decompensated cirrhosis is characterized by high hospitalization rates and costs, frequent readmissions, and poor short-term survival. Patients admitted to the hospital with acute variceal bleeding and/or hepatic encephalopathy and/or renal dysfunction are at serious risk for developing infection and/or sepsis; in turn, this renders them highly susceptible to the development of multi-system organ failure. The lack of standardized intensive care unit management protocols in patients with cirrhosis along with only few data reports from longitudinal clinical trials makes it difficult for hepatologists and critical care specialists to provide uniform evidence for clinical practice that could safely consolidate favorable outcomes such as lower hospitalization rates and/or mortality. Based on a rigorous online search of the scientific literature as well as a longtime clinical experience of the authors in the field of hepatology and critical care medicine, this work represents a focused effort to elucidate the specific bio-morbidity of advanced liver diseases in relation to the aforementioned challenges in clinical management. Further meta-analyses and/or systematic reviews are needed to enable clinicians to develop more effective strategies to bridge patients with decompensated liver disease to recompensation or liver transplantation.

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“…Cirrhotic children can have well-compensated disease with little symptoms or present with decompensated disease, including ascites, encephalopathy, gastrointestinal bleeding, portal hypertension, hepatorenal syndrome, sepsis, dyspnea, nausea, vomiting, jaundice, elongation in prothrombin time, hypotension, pleural effusion, fever, peptic ulcer, chlolelithiasis, renal failure, adrenal failure and hyponatremia [4][5][6].…”

Section: Effects Of End-stage Liver Disease On Pediatric Patientmentioning

confidence: 99%

Sedation for Pediatric Patient with End-Stage Hepatic Disease Outside Operating Room

Çankaya¹

2017

J Gastrointest Dig Syst

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Sedation outside operating room for children has increasing importance. Pediatric patients with end stage liver disease are of great importance for various and frequent procedures including gastrointestinal endoscopy, magnetic resonance imaging, computerized tomography, brachytherapy, catheterisation, interventional radiology. Anesthesia plan plays critical role for the success of these procedures. Patient safety, ventilation, hemodynamic responses, side effects of anesthetics on liver and periprocedural analgesia are the main topics of attention. Airway management tools may be helpful because of edema and ascites pushing diaphragm upwards. Nasal capnography enables monitoring spontaneous ventilation. Enlargement of extravascular extracellular fluid and dysproteinemia, effects drug behaviors. Drug elimination half-time as well as context sensitive half-time have to be taken into account and designed individually. The pressure above vena cava inferior, results with decrease in preload, thus reduction in cardiac output. Pulse wave variation monitoring helps for estimating circulating fluid status. Tendency for bleeding can be anticipated with fresh frozen plasma. Patient-controlled analgesia may be a choice of favor but close monitoring required for repeated analgesics. Children's Hospital of Eastern Ontario Pain Scale would be a good monitoring tool for pain.

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Intensive care management of patients with liver disease: proceedings of a single-topic conference sponsored by the Brazilian Society of Hepatology

Cited by 7 publications

References 97 publications

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

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

Intensive Care Therapy for Patients with Advanced Liver Diseases

Sedation for Pediatric Patient with End-Stage Hepatic Disease Outside Operating Room

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