Short-term prognosis in critically ill patients with liver cirrhosis: an evaluation of a new scoring system.
OBJECTIVE
The mortality of patients with liver cirrhosis admitted to an intensive care unit (ICU) has been found to be high. This study was performed to assess the physiological and laboratory parameters which are able to identify on ICU admission the cirrhotic patients who are most likely to die.


METHODS
Prospective clinical trial.


METHODS
Two groups of patients were analysed. Group A consisted of 196 consecutive cirrhotic patients admitted to our medical ICU for various reasons. For the detection of independent outcome predictors, we used a multiple logistic regression model. Based on these variables, the 'intensive care cirrhosis outcome (ICCO) score' was calculated. The ability to discriminate between survivors and non-survivors was determined by receiver operating characteristic curves, and the area under the curve was calculated. Group B consisted of 70 consecutive cirrhotic patients for prospective validation of the ICCO score.


RESULTS
Applying multiple logistic regression analysis, bilirubin, cholesterol, creatinine clearance and lactate were found to be independently associated with the hospital mortality. The ICCO score was 0.3707 + (0.0773 x bilirubin (mg/dl)) - (0.00849 x cholesterol (mg/dl)) -(0.0155 x creatinine clearance (ml/min)) + (0.1351 x lactate (mmol/l)), giving an area under a receiver operating characteristic curve of 0.9. Increasing score values were associated with an increase in mortality. All patients with an ICCO score > +2.6 died.


CONCLUSIONS
Application of the ICCO score is rapid and available at the patient's bedside, and its application is simple and reproducible. In cirrhotic patients, the ICCO score has a high ability to discriminate between survivors and non-survivors. The ICCO score may facilitate estimation on ICU admission of the prognosis of critically ill cirrhotic patients.
Zauner
C
C
Department of Internal Medicine IV, University of Vienna, Austria. Christian.Zauner@akh-wien.ac.at
Schneeweiss
B
B
Schneider
B
B
Madl
C
C
Klos
H
H
Kranz
A
A
Ratheiser
K
K
Kramer
L
L
Lenz
K
K
D019540:Area Under Curve; D016009:Chi-Square Distribution; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000401:mortality*; D008111:Liver Function Tests; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric