We collected data from patients with cirrhosis admitted to the ICU at Indiana University (IU-ICU) from December 1, 2006, through December 31, 2009 (n = 185), or at the University of Pennsylvania (Penn?ICU) from May 1, 2005, through December 31, 2010 (n = 206). Factors associated with mortality within 7 days of admission (7-d mortality) were determined by logistic regression analyses. A model was constructed based on the predictive parameters available on the first day of ICU admission in the IU-ICU cohort and then validated in the Penn?ICU cohort.
Median Model for End-stage Liver Disease (MELD) scores at ICU admission were 25 in the IU-ICU cohort (interquartile range, 23-34) and 32 in the Penn?ICU cohort (interquartile range, 26-41); corresponding 7-day mortalities were 28.3 % and 53.6 % , respectively. MELD score (odds ratio, 1.13; 95 % confidence interval [CI], 1.07-1.2) and mechanical ventilation (odds ratio, 5.7; 95 % CI, 2.3-14.1) were associated independently with 7-day mortality in the IU-ICU. A model based on these 2 variables separated IU-ICU patients into low-, medium-, and high-risk groups; these groups had 7-day mortalities of 9 % , 27 % , and 74 % , respectively (concordance index, 0.80; 95 % CI, 0.72-0.87; P < 10?8). The model was applied to the Penn-ICU cohort; the low-, medium-, and high-risk groups had 7-day mortalities of 33 % , 56 % , and 71 % , respectively (concordance index, 0.67; 95 % CI, 0.59-0.74; P < 10?4).
A model based on MELD score and mechanical ventilation on day 1 can stratify risk of early mortality in patients with cirrhosis admitted to the ICU. More studies are needed to validate this model and to enhance its clinical utility.