RIFLE classification as predictive factor of mortality in patients with cirrhosis admitted to intensive care unit.
OBJECTIVE
To evaluate the association of the Risk, Injury, Failure, Loss and End-stage renal failure (RIFLE) score on mortality in patients with decompensated cirrhosis admitted to intensive care unit (ICU).


METHODS
A cohort of 412 patients with cirrhosis consecutively admitted to ICU was classified according to the RIFLE score. Multivariable logistic regression analysis was used to evaluate the factors associated with mortality. Liver-specific, Acute Physiology and Chronic Health Evaluation (APACHE) II, Sequential Organ Failure Assessment (SOFA) and RIFLE scores on admission, were compared by receiver-operator characteristic curves.


RESULTS
The overall mortality during ICU stay or within 6 weeks after discharge from ICU was 61.2%, but decreased over time (76% during first interval, 1989-1992 vs 50% during the last, 2005-2006, P < 0.001). Multivariate analysis showed that RIFLE score (odds ratio: 2.1, P < 0.001) was an independent factor significantly associated with mortality. Although SOFA had the best discrimination (area under receiver-operator characteristic curve = 0.84), and the APACHE II had the best calibration, the RIFLE score had the best sensitivity (90%) to predict death in patients during follow up.


CONCLUSIONS
RIFLE score was significantly associated with mortality, confirming the importance of renal failure in this large cohort of patients with cirrhosis admitted to ICU, but it is less useful than other scores.
The Royal Free Sheila Sherlock Liver Centre and Department of Surgery, Royal Free Hospital, Hampstead, London NW3 2QG, UK.
Evangelos
E
Cholongitas
Vincenza
V
Calvaruso
Marco
M
Senzolo
David
D
Patch
Steve
S
Shaw
James
J
O'Beirne
Andrew K
AK
Burroughs
D018806:APACHE; D058186:Acute Kidney Injury / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D000328:Adult; D002423:Cause of Death; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D007362:Intensive Care Units / Q000706:statistics & numerical data*; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D015203:Reproducibility of Results; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D013997:Time Factors