Organ System Failure Scoring System Can Predict Hospital Mortality in Critically Ill Cirrhotic Patients

Tsai, Ming Hung; Chen, Yung Chang; Ho, Yu Pin; Lien, Jau Min; Chiu, Cheng‐Tang; Liu, Nai Jen; Chen, Pang Chi

doi:10.1097/00004836-200309000-00011

Cited by 63 publications

(62 citation statements)

References 25 publications

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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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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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“…These scoring systems have been validated to predict the outcomes of critically ill patients with cirrhosis. [22][23][24][25][26][27] For these scoring systems and physiological evaluations, the most abnormal value for each organ system on the day of the SST was recorded.…”

Section: Methodsmentioning

confidence: 99%

Adrenal insufficiency in patients with cirrhosis, severe sepsis and septic shock

et al. 2006

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Patients with cirrhosis are susceptible to bacterial infection, which can result in circulatory dysfunction, renal failure, hepatic encephalopathy, and a decreased survival rate. Severe sepsis is frequently associated with adrenal insufficiency, which may lead to hemodynamic instabity and a poor prognosis. We evaluated adrenal function using short corticotropin stimulation test (SST) in 101 critically ill patients with cirrhosis and severe sepsis. Adrenal insufficiency occurred in 51.48% of patients. The patients with adrenal insufficiency had a higher hospital mortality rate when compared with those with normal adrenal function (80.76% vs. 36.7%, P < .001). The cumulative rates of survival at 90 days were 15.3% and 63.2% for the adrenal insufficiency and normal adrenal function groups, respectively (P < .0001). The hospital survivors had a higher cortisol response to corticotropin (16.2 ؎ 8.0 vs. 8.5 ؎ 5.9 g/dL, P < .001). The cortisol response to corticotropin was inversely correlated with various disease severity, Model for End-Stage Liver Disease, and Child-Pugh scores. Acute physiology, age, chronic health evaluation III score, and cortisol increment were independent factors to predict hospital mortality. Mean arterial pressure on the day of SST was lower in patients with adrenal insufficiency (60 ؎ 14 vs. 74.5 ؎ 13 mm Hg, P < .001 ), and a higher proportion of these patients required vasopressors (73% vs. 24.48%, P < .001). Mean arterial pressure, serum bilirubin, vasopressor dependency, and bacteremia were independent factors that predicted adrenal insufficiency. In conclusion, adrenal insufficiency is common in critically ill patients with cirrhosis and severe sepsis. It is related to functional liver reserve and disease severity and is associated with hemodynamic instability, renal dysfunction, and increased mortality. (HEPATOLOGY 2006;43:673-681.) C ritical illness is accompanied by the activation of the hypothalamic-pituitary-adrenal (HPA) axis, which is highlighted by increased serum corticotropin and cortisol levels. [1][2][3] The activation of the HPA axis is a crucial component of the host's adaptation to severe stress. Cortisol is essential for the normal function of the immune system, maintenance of vascular tone, and various cellular functions. In patients with severe sepsis, the integrity of the HPA axis can be impaired by a variety of mechanisms. 1,4 Recently, the concept of relative adrenal insufficiency has been used to describe a subnormal adrenal response to adrenocorticotropin in severe illness, in which the cortisol levels, even though high in terms of absolute value, are inadequate to control the inflammatory situation. 1 The short corticotropin stimulation test (SST) is most commonly used to evaluate the appropriateness of the adrenal response in this setting. In patients with septic shock, a decreased response to the SST, namely, an absolute increment of the serum cortisol level less than 9 g/dL, is associated with an impaired vascular reactivity to vasopressors 5 and a high mortalit...

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“…The modification of diet in renal disease (MDRD) formula was applied for 12 patients to estimate baseline SCr concentrations as those patients admitted directly to the ICU and their previous SCr levels on admission were unknown [24]. Respiratory failure is defined as a respiratory rate of ≤5/min or ≥50/min and/or mechanical ventilation for ≥3 days and/or fraction of inspired oxygen (FiO 2 ) >0.4 and/or positive end-expiratory pressure >5 cm H 2 O [4,5,9]. Sepsis was defined according to the American College of Chest Physicians/Society of Critical Care Medicine (ACCP/SCCM) Consensus Conference [27].…”

Section: Definitionsmentioning

confidence: 99%

“…Multiple organ failure or dysfunction typically entails a very poor outcome in all ICU patients [4], and particularly in critically ill cirrhotic patients who develop an extrahepatic organ system failure or dysfunction [5,6]. Among the extrahepatic organ system failures often encountered in end-stage liver disease, renal failure or dysfunction in cirrhotic patients has been the subject of extensive investigation because of the functional nature, at least in part, and the capability of predicting morbidity and mortality [7,8].…”

Section: Introductionmentioning

confidence: 99%

Outcome predictors and new score of critically ill cirrhotic patients with acute renal failure

Tsai¹,

Tian²,

Jenq³

et al. 2008

Nephrology Dialysis Transplantation

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Background. End-stage liver disease is often complicated by renal function disturbances. Cirrhotic patients with acute renal failure admitted to intensive care units (ICUs) have high mortality rates. This work seeks to identify specific predictors of hospital mortality in critically ill cirrhotic patients with acute renal failure. Methods. A total of 111 patients with cirrhosis and acute renal failure were admitted to ICU from March 2003 to February 2005. Twenty-six demographic, clinical and laboratory variables were prospectively gathered as predictors of survival on the first day of ICU admission. Results. The overall hospital mortality rate was 81.1%. The univariate analysis identified 11 of the 32 variables as prognostically valuable. The multiple logistic regression analysis (excluding five scoring systems) indicates that the mean arterial pressure (MAP), serum bilirubin, respiratory failure and sepsis on the first day in ICU are significantly related to prognosis. The best Youden index (sensitivity + specificity − 1) yields cutoff points of 80 MAP (in mmHg) and 80 serum bilirubin (in µmol/L) (or 4.7 mg/dL) and indicates acute respiratory failure and sepsis. A simple model for mortality is developed on the basis of these four readily available parameters on Day 1 of ICU admission. The new score (MBRS score: MAP + bilirubin + respiratory failure + sepsis) displays an excellent area under the receiver operating characteristic curve (0.898 ± 0.031, P < 0.001). The mortality rate exceeds 90% when the MBRS (MAP + bilirubin + respiratory failure + sepsis) score is 2 or higher. Conclusion. The MBRS score is a straightforward, reproducible and easily adopted evaluative tool with good prognostic abilities, which generates objective data for patient families and physicians and supplements a clinical judgment of prognosis.

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Organ System Failure Scoring System Can Predict Hospital Mortality in Critically Ill Cirrhotic Patients

Cited by 63 publications

References 25 publications

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

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

Adrenal insufficiency in patients with cirrhosis, severe sepsis and septic shock

Outcome predictors and new score of critically ill cirrhotic patients with acute renal failure

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