Validation and analysis of prognostic scoring systems for critically ill patients with cirrhosis admitted to ICU
Joseph Campbell1, Joanne McPeake2, Martin Shaw3
1Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK. 1007950c@student.gla.ac.uk.
Insights
The CTP+L score, combining Child-Turcotte Pugh score with lactate levels, and the Royal Free Hospital score effectively predict intensive care unit mortality in cirrhosis patients. These tools offer improved accuracy over existing methods for this vulnerable population.
Area of Science:
- Critical Care Medicine
- Hepatology
- Prognostic Biomarkers
Background:
- Rising ICU admissions for liver cirrhosis patients present challenges for existing mortality prediction tools.
- Current scoring systems demonstrate poor performance in predicting ICU mortality for cirrhosis patients.
- A novel CTP+L score, integrating Child-Turcotte Pugh score with lactate concentration, showed prior association with mortality.
Purpose of the Study:
- To validate the CTP+L scoring tool for predicting ICU mortality in cirrhosis patients.
- To identify significant predictors of mortality in ICU patients with cirrhosis.
- To explore the utility of the Royal Free Hospital (RFH) score in this cohort.
Main Methods:
- Two cohorts of ICU patients with cirrhosis were analyzed (Glasgow: 84 patients, London: 115 patients).
- Liver-specific and general ICU scoring tools were calculated and compared using ROC curves.
- Univariate and multivariate analyses identified independent predictors of ICU mortality.
Main Results:
- Lactate, Bilirubin, PaO2/FiO2 Ratio, and PT ratio were independent predictors of mortality in the Glasgow cohort.
- Lactate, PT ratio, Bilirubin, PaO2/FiO2 Ratio, and Ascites were independent predictors in the London cohort.
- The CTP+L and RFH scoring tools demonstrated the highest ROC values in both cohorts.
Conclusions:
- The CTP+L and RFH scoring tools are validated prognostic tools for predicting ICU mortality in cirrhosis patients.
- These validated tools offer improved prognostic accuracy for critically ill cirrhosis patients.
- The study confirms lactate as a key predictor of mortality in this population.
Introduction:
The number of patients admitted to ICU who have liver cirrhosis is rising. Current prognostic scoring tools to predict ICU mortality have performed poorly in this group. In previous research from a single centre, a novel scoring tool which modifies the Child-Turcotte Pugh score by adding Lactate concentration, the CTP + L score, is strongly associated with mortality. This study aims to validate the use of the CTP + L scoring tool for predicting ICU mortality in patients admitted to a general ICU with cirrhosis, and to determine significant predictive factors for mortality with this group of patients. This study will also explore the use of the Royal Free Hospital (RFH) score in this cohort.
Methods:
A total of 84 patients admitted to the Glasgow Royal Infirmary ICU between June 2012 and Dec 2013 with cirrhosis were included. An additional cohort of 115 patients was obtained from two ICUs in London (St George's and St Thomas') collected between October 2007 and July 2009. Liver specific and general ICU scoring tools were calculated for both cohorts, and compared using area under the receiver operating characteristic (ROC) curves. Independent predictors of ICU mortality were identified by univariate analysis. Multivariate analysis was utilised to determine the most predictive factors affecting mortality within these patient groups.
Results:
Within the Glasgow cohort, independent predictors of ICU mortality were identified as Lactate (p < 0.001), Bilirubin (p = 0.0048), PaO2/FiO2 Ratio (p = 0.032) and PT ratio (p = 0.012). Within the London cohort, independent predictors of ICU mortality were Lactate (p < 0.001), PT ratio (p < 0.001), Bilirubin (p = 0.027), PaO2/FiO2 Ratio (p = 0.0011) and Ascites (p = 0.023). The CTP + L and RFH scoring tools had the highest ROC value in both cohorts examined.
Conclusion:
The CTP + L and RFH scoring tool are validated prognostic scoring tools for predicting ICU mortality in patients admitted to a general ICU with cirrhosis.
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