Increased Survival for Patients with Cirrhosis and Organ Failure in Liver Intensive Care and Validation of the Chronic Liver Failure-Sequential Organ Failure Scoring System.
Clin Gastroenterol Hepatol. 2014 Sep 17;
Authors: McPhail MJ, Shawcross DL, Abeles RD, Chang A, Patel V, Lee GH, Abdulla M, Sizer E, Willars C, Auzinger G, Bernal W, Wendon JA
BACKGROUND: & Aims: During the last decade, survival has increased among patients admitted to general intensive care units, but it is not clear if it has increased for patients admitted with cirrhosis and organ failure. The chronic liver failure-sequential organ failure assessment (CLIF-SOFA) was recently developed, as an adaptation to the SOFA, to predict outcomes of patients, but requires validation. We investigated changes in outcomes of patients with cirrhosis and organ failure since 2000, compared the abilities of SOFA and CLIF-SOFA to predict patient survival, and validated the CLIF-SOFA system.
METHODS: In a retrospective study, we collected data from 971 patients (median age, 52 years; age range, 16-90 years; 62% male) with cirrhosis (54% alcohol associated, 12% viral, and 34% other causes). The patients were admitted under emergency conditions, 1 January 2000-31 December 2010, to a liver intensive therapy unit in the United Kingdom. Patient survival while in the hospital was compared with measures of illness severity, acute physiology and chronic health evaluation (APACHE) II scores, model for end stage liver disease (MELD) scores, SOFA scores, and CLIF-SOFA scores.
RESULTS: Patients had a median APACHE II score of 21 (range, 5-50) and a median MELD score of 23 (range, 6-40). The median APACHE II score upon admission fell from 23 to 22 over the study period (P<.001), while the median MELD score upon admission fell from 23 to 18 (P<.001). Overall survival until hospital discharge was 51%; this value increased from 40% in 2000 to 63% in 2010 (P<.001). The unadjusted odds ratio (OR) for change in mortality/year was 0.87 (95% confidence interval, 0.83-0.91; P<.001). The APACHE II score-adjusted OR for mortality was 0.89 (95% confidence interval, 0.84-0.93; P<.001). Etiology of cirrhosis was not associated with significant difference in survival. CLIF-SOFA and SOFA scores at time of admission predicted patient survival with area under receiver operating curve (AUROC) values of 0.813 and 0.799, respectively; the scores at 48 hrs after admission predicted survival with AUROC values of 0.853 and 0.840, and scores after 1 week predicted survival with AUROC values of 0.842 and 0.844, respectively. These AUROC values were higher than those obtained from APACHE II or MELD scores.
CONCLUSIONS: The proportion of patients with cirrhosis who survived after admission to intensive care increased from 2000 to 2010. SOFA and CLIF-SOFA scores during the first week of critical care appear to have similar abilities to predict patient survival.
PMID: 25240417 [PubMed - as supplied by publisher]