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Organ system failure scoring system can predict hospital mortality in critically ill cirrhotic patients
Ming-Hung Tsai1, Yung-Chang Chen, Yu-Pin Ho
1Division of Gastroenterology, Chang Gung Memorial Hospital, Taipei, Taiwan.
Insights
Organ System Failure (OSF) scores accurately predict hospital mortality in critically ill cirrhotic patients admitted to the ICU. The OSF score demonstrated superior prognostic ability compared to the Child-Pugh classification.
Area of Science:
- Critical Care Medicine
- Hepatology
- Prognostic Biomarkers
Background:
- Critically ill cirrhotic patients admitted to the intensive care unit (ICU) face high mortality rates.
- Prognosis is significantly influenced by both hepatic and extrahepatic organ dysfunction.
Purpose of the Study:
- To compare the accuracy of Child-Pugh classification and Organ System Failure (OSF) scores in predicting hospital mortality.
- To evaluate these scores on the first day of ICU admission for critically ill cirrhotic patients.
Main Methods:
- Prospective data collection from 111 cirrhotic patients admitted to the ICU between July 2001 and June 2002.
- Calculation of Child-Pugh and OSF scores on the first day of ICU admission.
- Statistical analysis using Hosmer and Lemeshow goodness-of-fit and AUROC curves.
Main Results:
- Overall hospital mortality rate was 64.9%.
- OSF scores showed excellent discriminative power (AUROC 0.901), outperforming Child-Pugh scores (AUROC 0.748).
- OSF scores demonstrated a good fit according to the Hosmer and Lemeshow test.
Conclusions:
- The prognosis for cirrhotic patients in the ICU is generally poor.
- OSF score is a simple, reproducible tool with excellent prognostic capabilities.
- OSF scores provide objective data to aid clinical judgment and inform patient families and physicians.
Goals:
This study was conducted to assess and compare the accuracy of Child-Pugh classification and organ system failure (OSF) scores, obtained on the first day of ICU admission, in predicting the hospital mortality in critically ill cirrhotic patients.
Background:
Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated with high mortality rates. The prognosis of critically ill cirrhotic patients is determined by the extent of hepatic and extrahepatic organ dysfunction.
Study:
A total of 111 patients diagnosed with liver cirrhosis were admitted to medical ICU from July 2001 to June 2002. Information considered necessary to compute the Child-Pugh and OSF scores on the first day of ICU admission was prospectively collected.
Results:
The overall hospital mortality rate was 64.9%. Liver disease was most commonly attributed to hepatitis B viral infection. The OSF scores demonstrate a good fit using the Hosmer and Lemeshow goodness-of-fit test. Meanwhile, by using the areas under receiver operating characteristic (AUROC) curve, the OSF scores demonstrated an excellent discriminative power (AUROC 0.901), whereas the performance of Child-Pugh scores is clearly poorer (AUROC 0.748).
Conclusion:
This investigation confirms that the prognosis for cirrhotic patients admitted to ICU is grave. The OSF score is a simple, reproducible, and easily applied tool with excellent prognostic abilities that can provide objective information for patients' families and physicians and supplement the clinical judgment of prognosis.