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, Waqar H S; Shafqat, Farzana; Naqvi, Altaf Baqir

doi:10.1111/j.1572-0241.1998.00706.x

Cited by 44 publications

(21 citation statements)

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“…7 The predictive accuracies we found for the APACHE II and Child-Pugh systems in our sample compare well with data reported by Zauner et al 25 and Afessa and Kubilis. 27 The discriminatory power of the SOFA score seems to be superior to previously evaluated prognostic systems in cirrhotic patients.…”

Section: Discussionmentioning

confidence: 99%

“…25 The prognostic value of the APACHE II system (AUROC at admission 0.69, after 48 hours 0.78) was as good as the liver-specific scoring systems (i. model, which included renal insufficiency, Glasgow Coma Score, ventilatory insufficiency, age 65 years, and prolonged prothrombin time, that had a AUROC of 0.76 and 0.74 for death at 30 and 180 days, respectively. 26 Butt et al 27 prospectively compared the prognostic accuracy of the Child-Pugh and the APACHE III systems in predicting hospital mortality in 282 general ward patients with cirrhosis. The overall correctness of prediction values were 75% and 67% for the APACHE III and Child-Pugh systems, respectively.…”

Section: Discussionmentioning

confidence: 99%

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Short-term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems

et al. 2001

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The short-term prognosis of acutely ill patients with cirrhosis is influenced by the degree of hepatic insufficiency and by dysfunction of extrahepatic organ systems. The purpose of this study was to assess and compare the prognostic accuracy of the Child-Pugh classification, the Acute Physiology and Chronic Health Evaluation (APACHE) II system and the Sequential Organ Failure Assessment (SOFA) for predicting hospital mortality in patients with cirrhosis when used 24 hours after admission to a medical intensive care unit (ICU). Prospective data were recorded on 143 patients. Cumulative mortality rates were 36% in the ICU, 46% in the hospital, and 56% at 6-month follow-up. By using the area under receiver operating characteristic (AUROC) curves, the SOFA showed an excellent discriminative power (AU-ROC 0.94), which was clearly superior to the APACHE II (AUROC 0.79) and the Child-Pugh system (AUROC 0.74). Hospital mortality rates below and above a cutoff of 8 SOFA points were 4% and 88%, respectively (P < .0005). The SOFA score also reflected resource use during the ICU treatment as measured by daily workload and length of stay. The SOFA is an easily applied tool with excellent prognostic abilities and can be used to enhance clinical judgment of prognosis as well as providing patients and families with objective information. (HEPATOLOGY 2001;34:255-261.)

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Short-term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems

et al. 2001

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“…A PBE é importante causa de morte nos pacientes internados com cirrose (4) . Estudo desenvolvido em nosso meio (26) , avaliando a sobrevida do paciente cirrótico com ascite, demonstrou ser a PBE a terceira causa de morte neste grupo.…”

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Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

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Damo

et al. 2002

Arq. Gastroenterol.

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RESUMO -Racional -A peritonite bacteriana espontânea é complicação freqüente nos pacientes com cirrose e ascite, apresentando taxa de recurrência em 1 ano próxima de 70%. Objetivos -Avaliar a prevalência da peritonite bacteriana espontânea em pacientes com ascite por hepatopatia crônica e o impacto da sua presença na sobrevida dos mesmos. INTRODUÇÃOEstudos demonstram que 30% a 50% dos cirróticos apresentam infecções bacterianas na admissão hospitalar ou a desenvolvem durante a mesma (5,40) . Estas são responsáveis por até 25% das mortes nesta população de pacientes (5,28) .Dentre as infecções que acometem os pacientes com hepatopatia crônica, a de maior importância é a peritonite bacteriana espontânea (PBE) (5) .Entende-se por PBE a infecção do fluido de ascite sem haver um foco intra-abdominal aparente causal da infecção (15) .A PBE tem prevalência ao redor de 15% (1,5,18,44) , possuindo taxa de recurrência em 1 ano próxima de 70% (2,42) . Por outro lado, traz ao paciente cirrótico com ascite um empobrecimento no prognóstico tanto a curto, quanto a longo prazo, determinando mortalidade hospitalar, nos dias atuais, em torno de 20% (22,28,43) .Diante da escassez de estudos (5,14) que analisam a evolução dos pacientes com PBE em nosso País e também as diferenças regionais existentes, entende-se que esta infecção merece ser avaliada em nosso meio, com o intuito de observar seu comportamento nos dias atuais, permitindo assim, a busca de novas estratégias que visem melhorar seu prognóstico. Portanto, teve-se como objetivo principal, avaliar a prevalência da PBE e sua implicação na mortalidade hospitalar de pacientes com ascite secundária à hepatopatia crônica internados em um hospital geral.

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“…Since PT value is related to hepatic synthesis of proteins, it is widely used as a surrogate marker of liver function. Also, PT is one of the five parameters used to calculate Child's classes, the widely used system to assess the severity of liver cirrhosis [30]. Also, PT is crucially dependent on FVII, whose blood level is influenced by the liver functional mass.…”

Section: Discussionmentioning

confidence: 99%

Monitoring Coagulation Proteins During Progression of Liver Disease

et al. 2014

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This work was designated to monitor the coagulation abnormalities associated with the gradual progression of liver diseases. The study included fifty patients; forty were diagnosed with liver cirrhosis with different stages categorized according to the Childs-Pugh classification and another ten patients were diagnosed with hepatocellular carcinoma (HCC). Haemostatic variables including fibrinogen (FI), calcium (FIV), transglutaminase (FXIII), prothrombin time (PT) and platelet count were estimated in patients and compared with the baseline levels of healthy subjects (n = 10). The results demonstrated that the fibrinogen level was progressively decreased, whereas PT was progressively prolonged in Child A, Child B and Child C groups. The maximum deterioration was observed in HCC patients. Calcium significantly increased in mild (Child A) and moderate (Child B) but not in Child C cirrhosis and HCC patients. FXIII level did not show any significant changes in cirrhotic patients compared to healthy group. Some of the haemostatic variables we investigated were correlated with serum albumin and bilirubin but not with aminotransferases (ALT and AST). The results indicated that the haemostatic abnormalities in fibrinogen, calcium and PT (but not FXIII) were deteriorated in parallel with the gradual regression of the constitutional function of liver.

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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 44 publications

References 20 publications

Short-term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems

Short-term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems

Prevalência e prognóstico da peritonite bacteriana espontânea: experiência em pacientes internados em um hospital geral de Porto Alegre, RS, Brasil (1991-2000)

Monitoring Coagulation Proteins During Progression of Liver Disease

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