title: Prospective evaluation of the prognostic scores for cirrhotic patients admitted to an intensive care unit.
abstract: OBJECTIVE
  Cirrhotic patients admitted to an Intensive Care Unit (ICU) have a poor prognosis. Identifying patients in whom ICU care will be useful can be challenging. The aim of this study was to assess the predictive value of prognostic scores with respect to mortality and to identify mortality risk factors.
  
  
  METHODS
  Three hundred and seventy-seven cirrhotic patients admitted to a Liver ICU between May 2005 and March 2009 were enrolled in this study. Their average age was 55.5±11.4 years. The etiology of cirrhosis was alcohol (68%), virus hepatitis (18%), or mixed (5.5%). The main causes of hospitalization were gastrointestinal hemorrhage (43%), sepsis (19%), and hepatic encephalopathy (12%).
  
  
  RESULTS
  ICU and in-hospital mortality rates were 34.7% and 43.0%, respectively. Infection was the major cause of death (81.6%). ROC curve analysis demonstrated that SOFA (0.92) and SAPS II (0.89) scores calculated within 24h of admission predicted ICU mortality better than the Child-Pugh score (0.79) or MELD scores with (0.79-0.82) or without the incorporation of serum sodium levels (0.82). Statistical analysis showed that the prognostic severity scores, organ replacement therapy, and infection were accurate predictors of mortality. On multivariate analysis, mechanical ventilation, vasopressor therapy, bilirubin level at admission, and infection were independently associated with ICU mortality.
  
  
  CONCLUSIONS
  For cirrhotic patients admitted to the ICU, SAPS II, and SOFA scores predicted ICU mortality better than liver-specific scores. Mechanical ventilation or vasopressor therapy, bilirubin levels at admission and infection in patients with advanced cirrhosis were associated with a poor outcome.
authors.affiliation: AP-HP Hôpital Paul Brousse, Centre Hépato-Biliaire, Villejuif, France.
authors.forename: Eric
authors.initials: E
authors.lastname: Levesque
authors.forename: Emir
authors.initials: E
authors.lastname: Hoti
authors.forename: Daniel
authors.initials: D
authors.lastname: Azoulay
authors.forename: Philippe
authors.initials: P
authors.lastname: Ichaï
authors.forename: Houssam
authors.initials: H
authors.lastname: Habouchi
authors.forename: Denis
authors.initials: D
authors.lastname: Castaing
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
mesh_terms: D000328:Adult; D000368:Aged; D001663:Bilirubin / Q000097:blood; D015331:Cohort Studies; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D007239:Infections / Q000150:complications; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000150:complications / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012121:Respiration, Artificial; D012307:Risk Factors; D012720:Severity of Illness Index; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents; D001663:Bilirubin