Predicting mortality of patients with cirrhosis admitted to medical intensive care unit: An experience of a single tertiary center

Elzouki, Abdel-Naser; Suliman, Shireen; Alhasan, Rania; Abdullah, Afnizanfaizal; Othman, Muftah; Badi, Ahmad

doi:10.1016/j.ajg.2016.11.003

Cited by 14 publications

(12 citation statements)

References 30 publications

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“…In the study by Elzouki et al, HCV was the most common cause of chronic liver disease (33.9%), while Zhang et al found that hepatitis B virus (HBV) infection was the most common cause of chronic liver disease (54.5%) [10,11]. Other authors, Moreau et al and Dhiman et al, reported alcohol as the main cause of chronic liver disease (60% and 58%, respectively) [12,13].…”

Section: Discussionmentioning

confidence: 99%

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

Abbasy

Zaghla

Elhelbawy

et al. 2022

Egypt Liver Journal

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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.

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Section: Discussionmentioning

confidence: 99%

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

Abbasy

Zaghla

Elhelbawy

et al. 2022

Egypt Liver Journal

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“…They reported that the SOFA score was the best prognostic model for predicting mortality in all age groups but that the APACHE II and MELD scores were the best for patients who were over 60 years of age (P = 0.001 and P = 0.02, respectively). They reported that the CTP score was not a predictor of mortality (8). Hemida et al conducted a study including 60 patients with hepatitis C-related cirrhosis who were undergoing surgery under general anesthesia except for liver surgery.…”

Section: Discussionmentioning

confidence: 99%

Comparison of prognostic systems in cirrhotic patients with hepatic encephalopathy

Taş¹,

Yalçın²,

Sarıtaş³

et al. 2018

Turk J Med Sci

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Background/aim: There are various scoring systems for evaluating prognosis in patients hospitalized in intensive care units (ICUs) with hepatic encephalopathy. These include the Child-Turcotte-Pugh (CTP) classification, 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). In this study, we aimed to compare the various scoring systems to determine the best system for showing the prognosis of patients with a prior diagnosis of cirrhosis who were hospitalized for hepatic encephalopathy. Materials and methods: Patients with known cirrhosis hospitalized in the internal medicine ICU of the Adana Numune Education and Research Hospital with a diagnosis of hepatic encephalopathy were included in the study. Diagnosis and classification of hepatic encephalopathy were done according to the West Haven criteria. The etiology of hepatic encephalopathy was recorded for all patients. APACHE II, CLIF-SOFA, MELD, and CTP scores were calculated for all patients within the first 24 h. Outcomes of patients were recorded as either discharged or deceased. Demographic and biochemical data, duration of hospitalization, and prognostic factors were compared for both groups. Area under the receiver operating characteristic curve (AUROC) values were calculated for each scoring system. Results: A total of 84 patients were included in the study. The etiologies of encephalopathy were infection (n = 35, 41.7%), variceal bleeding (n = 19, 22.6%), constipation (n = 15, 17.9%), consuming excessive protein (n = 8, 9.5%), hypokalemia (n = 6, 7.1%), and hepatocellular carcinoma (n = 1, 1.2%). Nine patients had grade 1 encephalopathy, 34 patients had grade 2, 27 patients had grade 3, and 14 patients had grade 4. AUROC values were 0.986 (0.970-1.003), 0.974 (0.945-1.003), 0.955 (0.915-0.996), and 0.880 (0.800-0.959) for CLIF-SOFA, APACHE II, CTP, and MELD scores, respectively. Conclusion: We found the best prognostic model for patients who were hospitalized in the ICU for hepatic encephalopathy to be CLIFSOFA, followed by APACHE II, CTP, and MELD scores.

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“…Liu et al have shown that the initial APACHE II scores on the day of ICU admission are correlated with the outcomes of patients (16). A study that included 109 cirrhotic MICU patients reported that APACHE II could be used as a predictor of mortality (17). Notably, most currently available studies used APACHE II score within 24 h after admission, which is helpful in classifying patients and early identifying risk factors.…”

Section: Discussionmentioning

confidence: 99%

Dynamic APACHE II Score to Predict the Outcome of Intensive Care Unit Patients

et al. 2022

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ObjectiveThis study aims to evaluate the accuracy of the Acute Physiology and Chronic Health Evaluation (APACHE) II score on different days in predicting the mortality of critically ill patients to identify the best time point for the APACHE II score.MethodsThe demographic and clinical data are retrieved from the Medical Information Mart for Intensive Care (MIMIC)-IV dataset. APACHE II scores on days 1, 2, 3, 5, 7, 14, and 28 of hospitalization are calculated, and their performance is evaluated using the area under the receiver operating characteristic (AUROC) analysis. The cut-off for defining the high risk of mortality is determined using Youden's index. The APACHE II score on day 3 is the best time point to predict hospital mortality of ICU patients. The Hosmer-Lemeshow goodness-of-fit test is then applied to evaluate the calibration of the day 3 APACHE II score.ResultsWe recruited 6,374 eligible subjects from the MIMIC-IV database. Day 3 is the optimal time point for obtaining the APACHE II score to predict the hospital mortality of patients. The best cut-off for day 3 APACHE II score is 17. When APACHE II score ≥17, the sensitivity for the non-survivors and survivors is 92.8 and 82.2%, respectively, and the positive predictive value (PPV) is 23.1%. When APACHE II socre <17, the specificity for non-survivors and survivors is 90.1 and 80.2%, respectively, and the negative predictive value (NPV) is 87.8%. When day-3 APACHE II is used to predict the hospital mortality, the AUROC is 0.743 (P <0.001). In the ≥17 group, the sensitivity of non-survivors and survivors is 92.2 and 81.3%, respectively, and the PPV is 30.3%. In the <17 group, the specificity of non-survivors and survivors is 100.0 and 80.2%, respectively, and the NPV is 81.6%. The Hosmer-Lemeshow test indicated day-3 APACHE II has a high predicting the hospital mortality (X2 = 6.198, P = 0.625, consistency = 79.4%). However, the day-1 APACHE II has a poor calibration in predicting the hospital mortality rate (X2 = 294.898, P <0.001).ConclusionDay-3 APACHE II score is an optimal biomarker to predict the outcomes of ICU patients; 17 is the best cut-off for defining patients at high risk of mortality.

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Predicting mortality of patients with cirrhosis admitted to medical intensive care unit: An experience of a single tertiary center

Cited by 14 publications

References 30 publications

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

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

Comparison of prognostic systems in cirrhotic patients with hepatic encephalopathy

Dynamic APACHE II Score to Predict the Outcome of Intensive Care Unit Patients

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