Risk models and scoring systems for predicting the prognosis in critically ill cirrhotic patients with acute kidney...

Area of Science:

• Critical Care Medicine
• Nephrology
• Hepatology

Background:

• Critically ill cirrhotic patients with acute kidney injury (AKI) admitted to intensive care units (ICUs) face extremely high mortality rates.
• The MBRS (Mean Arterial Pressure, Bilirubin, Respiratory failure, Sepsis) scoring system was previously proposed to assess prognosis on ICU admission.
• This study aimed to externally validate the MBRS scoring system's predictive accuracy in a new cohort of cirrhotic patients with AKI.

Purpose of the Study:

• To perform an external validation of the MBRS scoring system for predicting short-term mortality.
• To assess the reproducibility and ease of application of the MBRS scoring system in critically ill cirrhotic patients with AKI.

Main Methods:

• A prospective analysis of 190 cirrhotic patients with AKI admitted to the ICU between March 2008 and February 2011.
• Data on 31 demographic and clinical variables were collected on day 1 of ICU admission as potential mortality predictors.
• Statistical analysis included logistic regression and receiver operating characteristic (AUROC) curve analysis to evaluate the MBRS score's performance.

Main Results:

• The overall in-hospital and 6-month mortality rates were high at 73.2% and 83.2%, respectively.
• Hepatitis B viral infection was the most common cause of liver disease (43%).
• The MBRS score, along with APACHE III, independently predicted in-hospital mortality. MBRS demonstrated good discrimination with an AUROC of 0.863±0.032.

Conclusions:

• The MBRS scoring system is a reproducible and simple tool for predicting short-term prognosis in critically ill cirrhotic patients with AKI.
• External validation confirmed the MBRS system's ability to enhance prediction accuracy for this high-risk patient population.
• The MBRS score facilitates early risk stratification and clinical decision-making in the ICU setting.