Prospective evaluation of the prognostic scores for cirrhotic patients admitted to an Intensive Care Unit

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• 作者：Eric Levesque¹ ; Emir Hoti¹ ; Daniel Azoulay¹ ;   ; ² ;   ; ³ ; Philippe Ichaï ; ¹ ;   ; ² ;   ; ⁴ ; Houssam Habouchi¹ ; Denis Castaing¹ ;   ; ² ;   ; ⁴ ; Didier Samuel¹ ;   ; ² ;   ; ⁴ ; Faouzi Saliba¹ ;   ; ² ;   ; ⁴ ;   ; ^{faouzi.saliba@pbr.aphp.fr}
• 关键词：Cirrhosis ; Prognostic scores ; Intensive Care Unit ; Outcome ; Mortality ; Model for End-Stage Liver Disease
• 刊名：Journal of Hepatology
• 出版年：2012
• 出版时间：January 2012
• 年：2012
• 卷：56
• 期：1
• 页码：95-102
• 全文大小：747 K

文摘

Background & Aims

Cirrhotic patients admitted to an Intensive Care Unit (ICU) have a poor prognosis. Identifying patients in whom ICU care will be useful can be challenging. The aim of this study was to assess the predictive value of prognostic scores with respect to mortality and to identify mortality risk factors.

Methods

Three hundred and seventy-seven cirrhotic patients admitted to a Liver ICU between May 2005 and March 2009 were enrolled in this study. Their average age was 55.5 ¡À 11.4 years. The etiology of cirrhosis was alcohol (68 % ), virus hepatitis (18 % ), or mixed (5.5 % ). The main causes of hospitalization were gastrointestinal hemorrhage (43 % ), sepsis (19 % ), and hepatic encephalopathy (12 % ).

Results

ICU and in-hospital mortality rates were 34.7 % and 43.0 % , respectively. Infection was the major cause of death (81.6 % ). ROC curve analysis demonstrated that SOFA (0.92) and SAPS II (0.89) scores calculated within 24 h of admission predicted ICU mortality better than the Child¨CPugh score (0.79) or MELD scores with (0.79?.82) or without the incorporation of serum sodium levels (0.82). Statistical analysis showed that the prognostic severity scores, organ replacement therapy, and infection were accurate predictors of mortality. On multivariate analysis, mechanical ventilation, vasopressor therapy, bilirubin level at admission, and infection were independently associated with ICU mortality.

Conclusions

For cirrhotic patients admitted to the ICU, SAPS II, and SOFA scores predicted ICU mortality better than liver-specific scores. Mechanical ventilation or vasopressor therapy, bilirubin levels at admission and infection in patients with advanced cirrhosis were associated with a poor outcome.