Predicting in-hospital mortality of cirrhotic patients hospitalized with hepatic encephalopathy

Abstract

Background Hepatic encephalopathy (HE) is a serious condition associated with high rates of mortality. Many scoring systems are used to predict the outcome of HE in patients admitted to the intensive care unit (ICU). The most used scores are Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II). These scores were thoroughly investigated in HE associated with acute liver failure (type A). In the present study, we aimed to evaluate the prognostic value of these scores in patients with HE on a background of liver cirrhosis (type C). Two hundred cirrhotic patients hospitalized with HE were included in the study. Diagnosis and classification of HE were based on the West Haven criteria. APACHE II, CLIF-SOFA, MELD, MELD-Na, and CTP scores were calculated for all patients within the first 24 h after admission. According to survival outcomes, patients were categorized into either improved or deceased. Demographic, clinical, and laboratory data as well as prognostic scores were compared in both deceased and improved groups. The receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUROC) was calculated for each score. Backward logistic regression analysis was used to identify the predictors of mortality. Results 60.5% of patients were males. The mean age was 61.09 ± 8.94 years. The main precipitating factors of HE was infections predominantly spontaneous bacterial peritonitis (n = 108, 54.0%) followed by variceal bleeding (n = 39, 19.5%). All scores were significantly higher in the deceased patients. AUROC were 0.734 (CI95% 0.666–0.803), 0.717 (CI95% 0.647–0.787), 0.663 (CI95% 0.589–0.738), 0.626 (CI95% 0.549–0.704), and 0.609 (CI95% 0.531–0.686) for CLIF-SOFA, MELD-Na, MELD, APACHE II, and CTP scores, respectively. MELD, MELD-Na, and CLIF-SOFA scores were the independent predictors of mortality. Among these scores, CLIF-SOFA was the strongest independent predictor of mortality (OR = 1.142, CI95% = 0.888–1.467, p = 0.001). Conclusions CLIF-SOFA score was superior to other prognostic scores in predicting mortality in hospitalized patients with HE type C.

Predictive Factors for the Prognosis of Alcoholic Liver Cirrhosis

“…The impact of these scores was studied by Dupont et al on a group of 281 patients with cirrhosis admitted to the intensive care unit, who reported a mortality rate of 25.3% in a direct causal relationship with the important dimensions that were measured for the area under the curve (MELD-Na: AUROC 0.81; 95% CI: 0.76-0.87, respectively, CTP: AUROC 0.76; 95% CI: 0.70-0.82) [28]. On the other hand, we noticed that there was an increased level of accuracy regarding the MELD-Na score, determined by a much higher specificity (83% versus 64%) and an almost double positive predictive value (PPV) (58% versus 31%), results comparable to those presented in previous studies (Table 7) [29][30][31]. PPV: positive predictive value; NPV: negative predictive value; AUROC: area under the ROC curve.…”

Mortality burden due to liver cirrhosis and hepatocellular carcinoma in Ghana; prevalence of risk factors and predictors of poor in-hospital survival

“…In their paper, and similar to findings, MELD-Na and hepatic encephalopathy were independent predictors of mortality [14]. As with our findings, MELD-Na score, Child-Pugh score and elevated WBC have also been demonstrated as predictive of mortality in studies in Africa, including Egypt and Ivory Coast [36,41]. These findings suggest that mortality is higher in patients with more advanced liver disease.…”