title: The APACHE III score as preoperative indicator of patient outcome in liver transplantation after fulminant hepatic failure.
abstract: BACKGROUND
  Given the current organ shortage, an accurate assessment of the patient's outcome after orthotopic liver transplantation (OLTX) for fulminant hepatic failure (FHF) is crucial in order to determine the suitability for transplantation. The purpose of this study was to assess whether APACHE II and III scores would provide prognosis of posttransplant mortality.
  
  
  METHODS
  The study included 129 patients with FHF who underwent OLTX between 1988 and 2008. APACHE II and III scores were calculated one day before transplantation and correlated with postoperative mortality. The cohort consisted of 42 males and 87 females with a mean age of 32 ± 17 years.
  
  
  RESULTS
  Gender, age and etiology of FHF did not correlate with posttransplant survival (p=NS). The APACHE II score was not significantly higher amongst 30-day non-survivors (p = NS). Both patients who died during this period had a significantly higher APACHE III score compared to survivors (82 ± 19.4 vs. 62 ± 18, p<0.01). Patients with an APACHE III score > 68 had a significantly higher mortality rate (p<0.01). Cox regression analysis revealed the APACHE III score as a significant predictor of death (p<0.001). Each additional point in the APACHE III system raises the postoperative mortality by 3.1%.
  
  
  CONCLUSIONS
  The major advantage of the APACHE III score is that its application and prognostic ability is independent from etiology of FHF. This accurate and reproducible evaluation system could be useful to identify patients with poor outcome.
authors: Department of General, Visceral and Transplantation Surgery, Charité - Universitätsmedizin Berlin, Berlin, Germany. panagiotis.fkatas@charite.de
authors: Panagiotis
authors: P
authors: Fikatas
authors: Frank
authors: F
authors: Ulrich
authors: Ji-Eun
authors: JE
authors: Lee
authors: Igor M
authors: IM
authors: Sauer
authors: Sascha
authors: S
authors: Chopra
authors: Sven C
authors: SC
authors: Schmidt
authors: Andreas
authors: A
authors: Pascher
authors: Johann
authors: J
authors: Pratschke
mesh_terms: D018806:APACHE; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D017114:Liver Failure, Acute / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D016031:Liver Transplantation / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011184:Postoperative Period; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D016896:Treatment Outcome; D055815:Young Adult