Scoring systems for 6-month mortality in critically ill cirrhotic patients: a prospective analysis of chronic liver failure - sequential organ failure assessment score (CLIF-SOFA)

Abstract

Summary Background Cirrhotic patients admitted to intensive care units (ICUs) have high mortality rates. The Chronic Liver Failure–Sequential Organ Failure Assessment (CLIF‐SOFA) score, a modified Sequential Organ Failure Assessment (SOFA) score, is a newly developed scoring system exclusively for patients with end‐stage liver disease. Aim To externally validate the efficacy of the CLIF‐SOFA score and evaluate other scoring systems for 6‐month mortality in critically ill cirrhotic patients. Methods This study prospectively recorded and analysed the data for 30 demographical parameters and some clinical characteristic variables on day 1 of 250 cirrhotic patients admitted to a 10‐bed specialised hepatogastroenterology ICU in a 2000‐bed tertiary care referral hospital during the period from September 2010 to August 2013. Results The overall in‐hospital and 6‐month mortality rate were 58.8% (147/250) and 78.0% (195/250), respectively. Liver diseases were mostly attributed to hepatitis B virus infection (32%). Multiple Cox logistic regression hazard analysis revealed that Glasgow coma scale, both the CLIF‐SOFA and Acute Physiology and Chronic Health Evaluation III (ACPACHE III) scores determined on the first day of ICU admission were independent predictors of 6‐month mortality. Analysis of the area under the receiver operating characteristic curve revealed that the CLIF‐SOFA score had the best discriminatory power (0.900 ± 0.020). Moreover, the cumulative 6‐month survival rates differed significantly for patients with a CLIF‐SOFA score ≤11 and those with a CLIF‐SOFA score >11 on the ICU admission day. Conclusion Both CLIF‐SOFA and APACHE III scores are excellent prognosis evaluation tools for critically ill cirrhotic patients.

Development of 365-day Life Expectancy Models: Application of Machine Learning Methods to a Prospective Study of Critically Ill Cirrhotic Patients (Preprint)

“…The cumulative survival rates differed significantly when classified by the SVM model (Figure 4). The results also showed that the predictive abilities of the SVM, RANSAC, Random Forest and Ensemble models were stronger than CLIF-SOFA scores (Table 5), which we previously found was the best model available [4].…”

“…The severity of illness was also assessed using Acute Physiology And Chronic Health Evaluation (APACHE) II, APACHE III, SOFA and CLIF-SOFA scores. The CLIF-SOFA score was based on a six organ system [4]. The worst physiological and biochemical values determined on the first day of ICU admission were recorded.…”

“…The high mortality rate is attributed to multiple organ dysfunction [1][2][3]. Disturbed systemic circulation in end-stage liver disease is caused by arterial vasodilation in the splanchnic circulation, reduced total peripheral vascular resistance and arterial pressure causing a secondary increase in cardiac output [4][5][6]. These abnormalities can result in severe crucial cirrhotic complications such as hepatocardiac syndrome, hepatorenal syndrome, hepatic encephalopathy, hepatopulmonary syndrome, coagulopathy and jaundice [7][8][9][10].…”

“…The European Association for the Study of Liver/Chronic Liver Failure Consortium further modified the parameters of SOFA according to specific factors associated with end-stage liver disease and proposed the Chronic Liver Failure Sequential Organ Failure Assessment (CLIF-SOFA) score to replace the SOFA score and define acute-on-chronic-liver-failure (ACLF) [14]. Our previous study validated that the CLIF-SOFA score was independently associated with in-hospital mortality and had better discriminatory power than the SOFA score for predicting 6-month mortality in critically ill cirrhotic patients [4]. However, the accuracy of the long-term prognosis of critically ill cirrhotic patients is still insufficient.…”

Perioperative Risk Assessment and Management of Cirrhotic Patients

“…Disturbed arterial splanchnic vasodilation, reduced total peripheral resistance and arterial pressure, impaired β-adrenergic pathways and cardiomyocyte plasma membrane function, result in secondary cardiac output increase and reduced function [41,44,49] known as cirrhotic cardiomyopathy (CC) ( Table 1) [50][51][52]. This can be diagnosed by cardiac MRI, EKG, or echocardiography, despite the lack of CC specific trials [50][51][52], preoperative management includes aldosterone antagonists, maintaining albumin, and ACEi caution due to decreased systemic vascular resistance (Table 1) [50][51][52][53][54].…”