Clinical value of APACHE scores in patients who require intensive care before liver transplantation

Although many prognostic indices have been used to predict outcomes after liver transplantation, the actual correlations between these indices and outcomes are inconsistent. The APACHE scoring system, which reflects a patient's clinical course, may be a better prognostic indicator of outcomes after liver transplantation.

Of 621 liver transplant recipients from January 2000 through December 2004, 41 adult patients with hepatic failure received ICU care prior to liver transplantation. Their records were analyzed retrospectively and the correlation between APACHE score and mortality after liver transplantation was determined.

Of the 41 patients with fulminant hepatic failure, 31 survived after liver transplantation. The mean APACHE II scores of the survivors and nonsurvivors differed significantly (22.50+/-5.89 vs 18.19+/-5.89, p<0.05), as did the mean APACHE III scores (100+/-22.6 vs. 78.3+/-23.9, p<0.05). The r2 between APACHE III scores and post-operative ICU stay was 0.14. The areas under the receiver operating characteristic (ROC) curve for APACHE II and APACH III were 0.713 and 0.737, respectively (P<0.05).

The APACHE scoring systems have significant clinical values in predicting the outcomes after urgent liver transplantation in patients with fulminant hepatic failure.