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Outcome prediction for critically ill cirrhotic patients: a comparison of APACHE II and Child-Pugh scoring systems
Yu-Pin Ho1, Yung-Chang Chen, Chun Yang
1Division of Gastroenterology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan.
Insights
Critically ill cirrhotic patients admitted to the ICU have a high mortality rate. The APACHE II score is more accurate than the Child-Pugh score in predicting hospital mortality for these patients.
Area of Science:
- Hepatology
- Critical Care Medicine
- Prognostic Biomarkers
Background:
- Cirrhosis patients in the medical intensive care unit (ICU) face high mortality.
- Prognosis is linked to hepatic and extrahepatic organ dysfunction severity.
Purpose of the Study:
- To compare the accuracy of Child-Pugh classification and APACHE II scores in predicting hospital mortality.
- To evaluate these scores upon ICU admission for critically ill cirrhotic patients.
Main Methods:
- Prospective data collection for 135 cirrhotic patients admitted to the ICU (January 2002-March 2003).
- Calculation of Child-Pugh and APACHE II scores on ICU admission day.
- Statistical analysis using Hosmer and Lemeshow goodness-of-fit and AUROC curves.
Main Results:
- Overall hospital mortality rate was 66.6%.
- APACHE II scores showed a better discriminative power (AUROC 0.833) than Child-Pugh scores (AUROC 0.75).
- APACHE II scores demonstrated a good fit via the Hosmer and Lemeshow test.
Conclusions:
- Critically ill cirrhotic patients admitted to the ICU have a grave prognosis.
- Both Child-Pugh and APACHE II scores predict outcomes, but APACHE II offers superior discrimination between survivors and non-survivors.
Abstract:
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. This study was conducted to assess and compare the accuracy of the Child-Pugh classification and APACHE II scores, obtained on the first day of ICU admission, in predicting hospital mortality in critically ill cirrhotic patients. One hundred thirty-five patients diagnosed with liver cirrhosis were admitted to the medical ICU between January 2002 and March 2003. Information considered necessary to compute the Child-Pugh and APACHE II scores on the first day of ICU admission was prospectively collected. The overall hospital mortality rate was 66.6%. Liver disease was most commonly attributed to hepatitis B viral infection. The APACHE II scores demonstrate a good fit using the Hosmer and Lemeshow goodness-of-fit test. Furthermore, by using the areas under receiver operating characteristic (AUROC) curve, the APACHE II scores demonstrated a better discriminative power (AUROC 0.833 +/- 0.039) than Child-Pugh scores (AUROC 0.75 +/- 0.05) (P=.024). This investigation confirms the grave prognosis for the cirrhotic patients admitted to the ICU. While both Child-Pugh and the APACHE II scores can satisfactorily predict the outcomes for critically ill cirrhotic patients, APACHE II is more powerful in discriminating the survivors from the nonsurvivors.
