Prognostic models in cirrhotics admitted to intensive care units better predict outcome when assessed at 48 h after admission

Cholongitas, Εvangelos; Betrosian, Alex P.; Senzolo, Marco; Shaw, Steve; Patch, David; Manousou, Pinelopi; O’Beirne, James; Burroughs, Andrew K.

doi:10.1111/j.1440-1746.2007.05269.x

Cited by 80 publications

(73 citation statements)

References 16 publications

(29 reference statements)

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“…These results are somewhat unsurprising if we bear in mind that the prognosis of acutely ill patients with cirrhosis is influenced not only by the severity of hepatic insufficiency but mainly by the dysfunction of other organ systems and that cirrhotics admitted to ICUs often have extrahepatic organ dysfunction and die of multiple organ failure (12)(13)(14)(34)(35)(36)(37)(38)(39).…”

Section: Introductionmentioning

confidence: 86%

Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

Freire

Romãozinho²,

Amaro³

et al. 2011

Rev. esp. enferm. dig.

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Aim: to assess the prognostic accuracy of Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) II, Sequential Organ Failure Assessment (SOFA), Model for End-stage Liver Disease (MELD) and ChildPugh-Turcotte (CPT) in predicting GICU mortality in cirrhotic patients.Methods: the study involved 124 consecutive cirrhotic admissions to a GICU. Clinical data, prognostic scores and mortality were recorded. Discrimination was evaluated with area under receiver operating characteristic curves (AUC). Calibration was assessed with Hosmer-Lemeshow goodness-of-fit test.Results: GICU mortality was 9.7%. Mean APACHE II, SAPS II, SOFA, MELD and CPT scores for survivors (13.6, 25.4, 3.5, 18.0 and 8.6, respectively) were found to be significantly lower than those of non-survivors (22.0, 47.5, 10.1, 30.7 and 12.5, respectively) (p < 0.001). All the prognostic systems showed good discrimination, with AUC = 0.860, 0.911, 0.868, 0.897 and 0.914 for APACHE II, SAPS II, SOFA, MELD and CPT, respectively. Similarly, APACHE II, SAPS II, SOFA, MELD and CPT scores achieved good calibration, with p = 0.146, 0.120, 0.686, 0.267 and 0.120, respectively. The overall correctness of prediction was 81.9%, 86.1%, 93.3%, 90.7% and 87.7% for the APA-CHE II, SAPS II, SOFA, MELD and CPT scores, respectively.Conclusions: in cirrhotics admitted to a GICU, all the tested scores have good prognostic accuracy, with SOFA and MELD showing the greatest overall correctness of prediction. INTRODUCTIONPrognostic models are used for comparison and quality assessment of different Intensive Care Units (ICUs) and within the same ICU over time, for audit and clinical research, for evaluating therapeutic effectiveness and for guiding discussions between clinicians and families (1-6).The incidence of liver cirrhosis is increasing exponentially and cirrhotic patients admitted to ICUs have high mortality rates and a high rate of consumption of resources (7-18). Furthermore, a significant percentage (36.7%) of the total cost of ICU care for cirrhotic patients is spent on those who do not survive (11,16,19). Additionally, it must be borne in mind that ICUs are a very limited health resource (10,11,18). Thus, predictive models could be very important decision-making tools in this setting.Two types of prognostic scores can be used in cirrhotics admitted to ICUs: general prognostic models and disease-specific models. The general prognostic models include two main categories: firstly, those evaluating severity of illness, namely the Acute Physiology and Chronic Health Evaluation (APACHE) II (20) and Simplified Acute Physiology Score (SAPS) II (21); secondly, models quantifying organ dysfunction and failure, of which the most widely-used is the Sequential Organ Failure Assessment (SOFA) (22,23 Vol. 103. N.° 4, pp. 177-183, 2011 Received: 04-10-10. Accepted: 02-12-10.

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Section: Introductionmentioning

confidence: 86%

Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

Freire

Romãozinho²,

Amaro³

et al. 2011

Rev. esp. enferm. dig.

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“…In addition, for the first time, we found that SOFA score at 48 hours postadmission is superior to SOFA score at admission in patients with acute complications of cirrhosis. 6 Dhiman et al 1 recognized that important survival factors, such as lactate, pH, phosphates, and ␣-fetoprotein, were not assessed in their study, as the data was collected retrospectively over almost 10 years. Currently, serum lactate is considered an established early prognostic marker of survival in patients with FHF.…”

mentioning

confidence: 99%

“…5 Interestingly, in the latter group of patients, lactate at 48 hours postadmission seems to have a greater impact on survival, compared to lactate at admission. 6 In the setting of FHF, evaluation of lactate at different time points seems to allow more precise assessment of prognosis. For example, similar to Macquillan et al, 7 we found that lactate at 12 hours postadmission had better prognostic accuracy, compared to lactate at admission in acetaminophen-induced FHF.…”

mentioning

confidence: 99%

Prognostic impact of lactate in acute liver failure

Betrossian¹,

Senzolo²,

Shaw

et al. 2007

Liver Transpl

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“…Özellikle erken postoperatif dönemde trombositlerin trombotik komplikasyonlarda önemli rol oynadığını düşünen bazı araştırmacılar trombosit sayısı <20x10 9 /L inmeden veya aktif kanama/sızıntı (diğer faktörler normal olmasına rağmen) olmadan TS transfüzyonu yapılmamasını önermişlerdir. Karaciğer biyopsisi, reoperasyon gibi invaziv girişimler öncesi trombosit sayısı >50x10 9 …”

Section: Postoperatif Kanama Koagülasyon Dengesi Ve Transfüzyon Tedaunclassified

“…Alıcının preoperatif durumu, intraoperatif cerrahi seyir, greft karaciğerin kalitesi, postoperatif enfeksiyon gelişmesi, immünosupresif ilaçların yan etkileri sonucu belirleyen önemli faktörlerdir. Alıcının preoperatif durumunun ciddiyeti ile sağkalım ters orantılı olmakla birlikte bu durum tek belirleyici olmadığından MELD (Model for End-Stage Liver Disease) ve APACHE (Acute Physiology and Chronic Health Evaluation) skorları yüksek olan kritik hastalarda bile KT başarılı olabilmektedir (9,10). Donör yaşı ve preoperatif MELD skoru baz alınarak geliştirilen D-MELD modelinde, skoru yüksek olanlarda (D-MELD>1600) kısa ve uzun dönemde anlamlı olarak daha kötü greft ömrü saptanmıştır (11).…”

Section: Introductionunclassified

Critical Care Management after Adult Liver Transplantation

Akan¹

2017

tybdd

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1ÖZ Karaciğer transplantasyonu uygulanan hastaların yoğun bakım yönetimi çok yönlü bir izlemi ve multidisipliner bir yaklaşımı gerektirir. Günümüzde ideal bir yoğun bakım tedavisi için deneyimli bir ekibe ve gelişmiş yoğun bakım/hastane olanaklarına gereksinim vardır. Karaciğer transplantasyon olgularının postoperatif yoğun bakım yönetimi zaman içinde hızlı bir gelişme göstermiştir. Preoperatif optimizasyon, cerrahi teknik, intraoperatif anestezi yönetimi, organ prezervasyonu, yoğun bakım ve immünosüpresyon tedavilerindeki gelişmeler ile 1998'de %79 düzeyinde olan karaciğer transplantasyonu sonrası bir yıllık sağkalım 2008'de %90'a yükselmiştir. Karaciğer transplantasyonlu olguların yoğun bakım yönetiminde özellikle hızlı kardiyorespiratuvar stabilizasyon, ağır koagülopatinin düzeltilmesi, mekanik ventilasyondan erken ayırma, uygun sıvı-elektrolit tedavisi, böbrek fonksiyonlarının korunması, greft rejeksiyonun önlenmesi ve enfeksiyon profilaksisi/tedavisi büyük önem taşır. Erken postoperatif dönem çok hassas bir süreç olduğundan yakın monitörizasyon, kardiyorespiratuvar fonksiyonların stabilizasyonu, greft fonksiyonunun sık değerlendirilmesi, komplikasyonların erken tanınması ve ekstrahepatik organ yetersizliklerinin hızlı tedavisi mortalite/morbiditenin azaltılabilmesi için zorunludur. Anahtar Kelimeler: Karaciğer transplantasyonu, postoperatif dönem, yoğun bakım, karaciğer yetersizliği ABSTRACT Critical care management after liver transplantation requires a sophisticated monitoring and multi-disciplinary team work. An experienced team and advanced critical care/hospital facilities are necessary for an ideal critical care treatment today. Critical care management after liver transplantation has shown a rapid development since the introduction of liver transplantation. While one-year survival rate after liver transplantation was 79% in 1998, it raised to 90% in 2008 related to the improvements in preoperative optimization, surgical technique, anesthetic management, organ preservation, critial care and immunosuppressive treatment. Treatment of severe coagulopathy, prompt hemodynamic and respiratory stabilization, early weaning from mechanical ventilation, proper fluid-electrolyte therapy, prevention of graft rejection, protection of renal functions and prophylaxis/treatment of infection are particularly important in critical care management after liver transplantation. As early postoperative period of liver transplantation is a critical phase; close monitoring, stabilization of cardiopulmonary functions, frequent evaluation of graft function, early diagnosis of complications and rapid treatment of extrahepatic organ failure are mandatory in order to reduce mortality/morbidity.

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Prognostic models in cirrhotics admitted to intensive care units better predict outcome when assessed at 48 h after admission

Abstract: In cirrhotics, prognostic scores in the ICU at 48 h had better discrimination than baseline scores for short-term mortality. SOFA and FOS models had the best performance.

Cited by 80 publications

References 16 publications

Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

Prognostic scores in cirrhotic patients admitted to a gastroenterology intensive care unit

Prognostic impact of lactate in acute liver failure

Critical Care Management after Adult Liver Transplantation

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