Predicting hospital mortality in cirrhotic patients: comparison of child-pugh and acute physiology, age and chronic health evaluation (APACHE III) scoring systems

Butt, Arshad Kamal; Khan, Abdul Wali; Alam, Altaf; Shah, S. W. H.; Shafqat, Farzana; Naqvi, Altaf Baqir

doi:10.1016/s0002-9270(98)00587-5

Cited by 28 publications

(18 citation statements)

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“…Because mathematical equations for APACHE III have not been published and for APACHE II this equation is available only for admission, these equations have not been used to calculate the relative risk of death. In agreement with other studies [34,35,37,39,40], we wanted to test the accuracy of single-score values. Patients admitted to a medical ICU during the first 24 hours of their presentation were excluded from our study, thus resulting in a mortality rate of only 11.5%.…”

Section: Discussionmentioning

confidence: 75%

“…Butt et al reported that by using discriminant analysis, APACHE III score correctly classified 75% of cases vs. 67% of cases for Child-Pugh score [40]. No cutoff values were reported, the overall model calibration was not tested and data from blood gas analysis were not included in the calculation of the APACHE III score, thus resulting in an incomplete score.…”

Section: Discussionmentioning

confidence: 99%

“…APACHE II has been previously used to risk stratify a mixed population of both ICU and non-ICU cirrhotic patients with upper gastrointestinal bleeding [39], while recently, an incomplete APACHE III score (i.e. a score in which data for blood gas analysis were omitted) has been reported to be superior to CPS in risk stratifying cirrhotic patients outside ICU settings [40]. …”

Section: Introductionmentioning

confidence: 99%

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A comparison of Child-Pugh, APACHE II and APACHE III scoring systems in predicting hospital mortality of patients with liver cirrhosis

et al. 2003

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Section: Discussionmentioning

confidence: 75%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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A comparison of Child-Pugh, APACHE II and APACHE III scoring systems in predicting hospital mortality of patients with liver cirrhosis

et al. 2003

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“…When admitted to an ICU, mortality for patients with cirrhosis is high [3]; recent data suggest greater than 37% ICU mortality and 49% hospital mortality [4,5]. Because of the poor odds for recovery despite aggressive interventions, several investigators have examined how scoring systems may be used to predict outcome and allocate resources in this cohort of ICU patients [6,7]. Much of this effort has focused on determining whether organ-specific scoring systems outperform traditional ICU scoring systems in predicting the risk of death.…”

Section: Introductionmentioning

confidence: 99%

Model for End-Stage Liver Disease score predicts mortality in critically ill cirrhotic patients

Boone

Celi

et al. 2014

Journal of Critical Care

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Purpose Cirrhosis is a common condition that complicates the management of patients who require critical care. There is interest in identifying scoring systems that may be used to predict outcome because of the poor odds for recovery despite high-intensity care. We sought to evaluate how Model for End-Stage Liver Disease (MELD), an organ-specific scoring system, compares with other severity of illness scoring systems in predicting short- and long-term mortality for critically ill cirrhotic patients. Materials and methods This was a retrospective cohort study involving seven intensive care units (ICUs) in a tertiary care, academic medical center. Adult patients with cirrhosis who were admitted to an ICU between 2001 and 2008 were evaluated. Severity of illness scores (MELD and Sequential Organ Failure Assessment [SOFA]) were calculated on admission and at 24 and 48 hours. The primary end points were 28-day and 1-year all-cause mortality. Results Of 19742 ICU hospitalizations, 848 had cirrhosis. Relevant data were available for 521 patients (73%). Of these cases, 353 patients (69.5%) were admitted to medical ICU (MICU), and the other 155 (30.5%), to surgical unit. Alcohol abuse and hepatitis C were the most common reasons for cirrhosis. Patients who died within 28 days were more likely to receive mechanical ventilation, pressors, and renal replacement therapy. Among 353 medical admissions, both MELD and SOFA were found to be significantly associated with both 28-day and 1-year mortality. Among the 155 surgical admissions, both scores were found to be not significant for 28-day mortality but were significant for 1 year. Conclusions Our results demonstrate that the prognostic ability of a variety of scoring systems strongly depends on the patient population. In the MICU population, each model (MELD + SOFA, MELD, and SOFA) demonstrates excellent discrimination for 28-day and 1-year mortality. However, these scoring systems did not predict 28-day mortality in the surgical ICU group but were significant for 1-year mortality. This suggests that patients admitted to a surgical ICU will behave similarly to their MICU cohort if they survive the perioperative period.

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“…1–4 The CTP currently used is calculated from 5 subscores, 3 based on objective clinical laboratory values, total bilirubin, serum albumin, and international normalized ratio (INR) and 2 subjective variables quantifying the severity of ascites and hepatic encephalopathy (HE) from none to mild (or medically controlled) to severe (or medically refractory). Although highly predictive of surgical risks, 5–9 hospital mortality, 10,11 post-transcatheter arterial embolization mortality, 12,13 transplantation waitlist mortality, 14 and long-term survival 15 in cirrhosis, its major limitations are the dependence on subjective variables and arbitrary laboratory cut points that have never been formally validated. 4 Because of the subjective nature of 2 of the CTP variables, it is challenging, time-consuming, and costly to manually extract all data required to calculate the CTP from historical data.…”

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confidence: 99%

Development and Performance of an Algorithm to Estimate the Child-Turcotte-Pugh Score From a National Electronic Healthcare Database

Kaplan

Dai

Aytaman

et al. 2015

Clinical Gastroenterology and Hepatology

106

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BACKGROUND & METHODS The Child-Turcotte-Pugh (CTP) score is a widely used and validated predictor of long-term survival in cirrhosis. The CTP score is a composite of 5 subscores, 3 based on objective clinical laboratory values and 2 subjective variables quantifying the severity of ascites and hepatic encephalopathy. To date, no system to quantify CTP score from administrative databases has been validated. The Veterans Outcomes and Costs Associated with Liver Disease study is a multicenter collaborative study to evaluate the outcomes and costs of hepatocellular carcinoma in the U.S. Veterans Health Administration. We developed and validated an algorithm to calculate electronic CTP (eCTP) scores by using data from the Veterans Health Administration Corporate Data Warehouse. METHODS Multiple algorithms for determining each CTP subscore from International Classification of Diseases version 9, Common Procedural Terminology, pharmacy, and laboratory data were devised and tested in 2 patient cohorts. For each cohort, 6 site investigators (Boston, Bronx, Brooklyn, Philadelphia, Minneapolis, and West Haven VA Medical Centers) were provided cases from which to determine validity of diagnosis, laboratory data, and clinical assessment of ascites and encephalopathy. The optimal algorithm (designated eCTP) was then applied to 30,840 cirrhotic patients alive in the first quarter of 2008 for whom 5-year overall and transplant-free survival data were available. The ability of the eCTP score and other disease severity scores (Charlson-Deyo index, Veterans Aging Cohort Study index, Model for End-Stage Liver Disease score, and Cirrhosis Comorbidity) to predict survival was then assessed by Cox proportional hazards regression. RESULTS Spearman correlations for administrative and investigator validated laboratory data in the HCC and cirrhotic cohorts, respectively, were 0.85 and 0.92 for bilirubin, 0.92 and 0.87 for albumin, and 0.84 and 0.86 for international normalized ratio. In the HCC cohort, the overall eCTP score matched 96% of patients to within 1 point of the chart-validated CTP score (Spearman correlation, 0.81). In the cirrhosis cohort, 98% were matched to within 1 point of their actual CTP score (Spearman, 0.85). When applied to a cohort of 30,840 patients with cirrhosis, each unit change in eCTP was associated with 39% increase in the relative risk of death or transplantation. The Harrell C statistic for the eCTP (0.678) was numerically higher than those for other disease severity indices for predicting 5-year transplant-free survival. Adding other predictive models to the eCTP resulted in minimal differences in its predictive performance. CONCLUSION We developed and validated an algorithm to extrapolate an eCTP score from data in a large administrative database with excellent correlation to actual CTP score on chart review. When applied to an administrative database, this algorithm is a highly useful predictor of survival when compared with multiple other published liver disease severity indices.

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Predicting hospital mortality in cirrhotic patients: comparison of child-pugh and acute physiology, age and chronic health evaluation (APACHE III) scoring systems

Abstract: The APACHE III scoring system is superior to Child-Pugh for prognosticating short term survival of cirrhotic patients. Prognostic accuracy of APACHE III can be enhanced by incorporating information regarding ascites and prothrombin time prolongation.

Cited by 28 publications

References 20 publications

A comparison of Child-Pugh, APACHE II and APACHE III scoring systems in predicting hospital mortality of patients with liver cirrhosis

A comparison of Child-Pugh, APACHE II and APACHE III scoring systems in predicting hospital mortality of patients with liver cirrhosis

Model for End-Stage Liver Disease score predicts mortality in critically ill cirrhotic patients

Development and Performance of an Algorithm to Estimate the Child-Turcotte-Pugh Score From a National Electronic Healthcare Database

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