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Short-term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems
M Wehler1, J Kokoska, U Reulbach
1Department of Medicine I and Medical Informatics, University of Erlangen-Nuremberg, Germany. markus.wehler@med1.imed.uni-erlangen.de
Insights
The Sequential Organ Failure Assessment (SOFA) score accurately predicts hospital mortality in critically ill cirrhosis patients. SOFA demonstrated superior prognostic ability compared to Child-Pugh and APACHE II systems.
Area of Science:
- Hepatology
- Critical Care Medicine
- Prognostic Biomarkers
Background:
- Prognosis in acutely ill cirrhosis patients depends on hepatic and extrahepatic organ function.
- Accurate short-term mortality prediction is crucial for managing these patients.
Purpose of the Study:
- To compare the prognostic accuracy of Child-Pugh, APACHE II, and SOFA scores.
- To evaluate these scores for predicting hospital mortality in intensive care unit (ICU) cirrhosis patients.
Main Methods:
- Prospective data collection from 143 cirrhosis patients admitted to a medical ICU.
- Assessment of Child-Pugh, APACHE II, and SOFA scores 24 hours post-admission.
- Analysis using area under receiver operating characteristic (AUROC) curves.
Main Results:
- SOFA demonstrated superior discriminative power (AUROC 0.94) compared to APACHE II (0.79) and Child-Pugh (0.74).
- Hospital mortality was 4% with SOFA ≤ 8 and 88% with SOFA > 8 (P <.0005).
- SOFA scores correlated with ICU resource utilization (workload, length of stay).
Conclusions:
- The SOFA score is a highly accurate and easily applicable tool for predicting hospital mortality in critically ill cirrhosis patients.
- SOFA enhances clinical judgment and provides objective prognostic information for patients and families.
Abstract:
The short-term prognosis of acutely ill patients with cirrhosis is influenced by the degree of hepatic insufficiency and by dysfunction of extrahepatic organ systems. The purpose of this study was to assess and compare the prognostic accuracy of the Child-Pugh classification, the Acute Physiology and Chronic Health Evaluation (APACHE) II system and the Sequential Organ Failure Assessment (SOFA) for predicting hospital mortality in patients with cirrhosis when used 24 hours after admission to a medical intensive care unit (ICU). Prospective data were recorded on 143 patients. Cumulative mortality rates were 36% in the ICU, 46% in the hospital, and 56% at 6-month follow-up. By using the area under receiver operating characteristic (AUROC) curves, the SOFA showed an excellent discriminative power (AUROC 0.94), which was clearly superior to the APACHE II (AUROC 0.79) and the Child-Pugh system (AUROC 0.74). Hospital mortality rates below and above a cutoff of 8 SOFA points were 4% and 88%, respectively (P <.0005). The SOFA score also reflected resource use during the ICU treatment as measured by daily workload and length of stay. The SOFA is an easily applied tool with excellent prognostic abilities and can be used to enhance clinical judgment of prognosis as well as providing patients and families with objective information.