Clinical value of APACHE scores in patients who require intensive care before liver transplantation.
OBJECTIVE
Although many prognostic indices have been used to predict outcomes after liver transplantation, the actual correlations between these indices and outcomes are inconsistent. The APACHE scoring system, which reflects a patient's clinical course, may be a better prognostic indicator of outcomes after liver transplantation.


METHODS
Of 621 liver transplant recipients from January 2000 through December 2004, 41 adult patients with hepatic failure received ICU care prior to liver transplantation. Their records were analyzed retrospectively and the correlation between APACHE score and mortality after liver transplantation was determined.


RESULTS
Of the 41 patients with fulminant hepatic failure, 31 survived after liver transplantation. The mean APACHE II scores of the survivors and nonsurvivors differed significantly (22.50+/-5.89 vs 18.19+/-5.89, p<0.05), as did the mean APACHE III scores (100+/-22.6 vs. 78.3+/-23.9, p<0.05). The r2 between APACHE III scores and post-operative ICU stay was 0.14. The areas under the receiver operating characteristic (ROC) curve for APACHE II and APACH III were 0.713 and 0.737, respectively (P<0.05).


CONCLUSIONS
The APACHE scoring systems have significant clinical values in predicting the outcomes after urgent liver transplantation in patients with fulminant hepatic failure.
Park
Kwang-Min
KM
Division of HBP Surgery and Liver transplantation, Department of Surgery, University of Ulsan College of Medicine, Seoul, Korea. kmpark@amc.seoul.kr
Kim
Ki-Hun
KH
Lee
Sung-Gyu
SG
Lee
Young-Joo
YJ
Hwang
Shin
S
Ahn
Chul-Soo
CS
Moon
Deok-Bog
DB
Ha
Tae-Yong
TY
Song
Gi-Won
GW
Jung
Dong-Hwan
DH
Kim
Hong Jin
HJ
D018806:APACHE; D000328:Adult; D019540:Area Under Curve; D003422:Critical Care; D005260:Female; D006801:Humans; D007902:Length of Stay; D008103:Liver Cirrhosis / Q000150:complications / Q000601:surgery; D017114:Liver Failure, Acute / Q000209:etiology / Q000601:surgery; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D055815:Young Adult