Cirrhotic patients in the ICU: prognostic markers and outcome

Give an update on the importance of prognostic scores at admission to the ICU for defining short-term outcome in critically ill cirrhotic patients. Highlight the correlation between the development of sepsis and/or organ failure and outcome.

ICU mortality rate of cirrhotic patients admitted to the ICU ranges from 34 to 69%. Few improvements in the management of these patients occurred during the last decade. Definitive treatment relies mainly on the availability of transplant organs. ICU scores (mainly Sequential Organ Failure Assessment score) when performed at admission or within 2-4 days from admission are superior to liver specific scores (Model for End-Stage Liver Disease and Child-Pugh scores) to determine outcome. Cirrhotic patients with three or more organ failures have higher mortality then general ICU patients in the same condition. An attempt to define an entity called 'acute on chronic liver failure' that characterizes better those patients with worse outcomes according to the numbers of organ failures is currently undergoing.

Early referral of cirrhotic patients to ICU before the development of multiple extrahepatic organ failure is essential to improve outcome. Current scores should be used only for clinical trials and not to determine the potential futility or costs of an ICU admission.