Prospective cohort study comparing sequential organ failure assessment and acute physiology, age, chronic health evaluation III scoring systems for hospital mortality prediction in critically ill cirrhotic patients

Abstract

The aim of the study was to evaluate the usefulness of sequential organ failure assessment (SOFA) and acute physiology, age, chronic health evaluation III (APACHE III) scoring systems obtained on the first day of intensive care unit (ICU) admission in predicting hospital mortality in critically ill cirrhotic patients. The study enrolled 102 cirrhotic patients consecutively admitted to ICU during a 1-year period. Twenty-five demographic, clinical and laboratory variables were analysed as predicators of survival. Information considered necessary to calculate the Child-Pugh, SOFA and APACHE III scores on the first day of ICU admission was also gathered. Overall hospital mortality was 68.6%. Multiple logistic regression analysis revealed that mean arterial pressure, SOFA and APACHE III scores were significantly related to prognosis. Goodness-of-fit was good for the SOFA and APACHE III models. Both predictive models displayed a similar degree of the best Youden index (0.68) and overall correctness (84%) of prediction. The SOFA and APACHE III models displayed good areas under the receiver-operating characteristic curve (0.917 +/- 0.028 and 0.912 +/- 0.029, respectively). Finally, a strong and significant positive correlation exists between SOFA and APACHE III scores for individual patients (r(2) = 0.628, p < 0.001). This investigation confirms the grave prognosis for cirrhotic patients admitted to ICU. Both SOFA and APACHE III scores are excellent tools to predict the hospital mortality in critically ill cirrhotic patients. The overall predictive accuracy of SOFA and APACHE III is superior to that of Child-Pugh system. The role of these scoring systems in describing the dynamic aspects of clinical courses and allocating ICU resources needs to be clarified.

Outcome predictors and new score of critically ill cirrhotic patients with acute renal failure

“…Moreover, the predictive accuracy and discriminative power for Child-Pugh points in this study are comparable with those from previous reports [1,5]. The Child-Pugh score reveals the severity of underlying liver disease but is not the ideal tool for predicting mortality or resource usage in cirrhotic patients with multiple organ failure [3,5]. The lack of extrahepatic parameters in the ChildPugh score and the lack of liver-specific prognostic factors in the APACHE II score may account for their significant inferiority to MBRS scores in discriminative capability (Table 6).…”

“…The prognosis of cirrhotic patients admitted to the intensive care unit (ICU) has been graved [1][2][3]. Multiple organ failure or dysfunction typically entails a very poor outcome in all ICU patients [4], and particularly in critically ill cirrhotic patients who develop an extrahepatic organ system failure or dysfunction [5,6].…”

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

“…Two categories of prognostic models are commonly used: first, those evaluating the severity of illness: Acute Physiology and Chronic Health Evaluation (APACHE) II and III, Simplified Acute Physiology Score (SAPS) II, and Mortality Prediction Model II, which are most commonly used [70,96], and second, models quantifying organ dysfunction and failure: Logistic Organ Dysfunction System, Multiple Organ Dysfunction Score, Organ System Failure (OSF), and Sequential Organ Failure Assessment (SOFA) [97]. The MELD was originally created and validated in patients in whom an acute reversible complication like bacterial infection or azotemia was not present and not designed to predict mortality in an ICU setting [98].…”

Prognóstico do paciente cirrótico admitido na terapia intensiva

“…(8) In more recent studies (from this decade), the mortality remains high, ranging between 54.7 and 73.6%. (9,(10)(11)(12) In contrast with these figures, a Cleveland Clinic Foundation's study in patients admitted between 1993 and 1998 reports lower mortality: ICU 36% and hospital 49%. (13) When the mortality was evaluated for a longer period, it was also shown to be high: one year cirrhotic patients mortality 69%, and five years 77%.…”