title: The outcome of critical illness in decompensated alcoholic liver cirrhosis.
abstract: BACKGROUND
  The mortality of patients suffering from acute decompensated liver disease treated in the intensive care unit (ICU) varies between 50% and 100%. Previously published data suggest that liver-specific score systems are less accurate compared with the ICU-specific scoring systems acute physiology and chronic health evaluation II (APACHE II) and simplified organ failure assessment (SOFA) in predicting outcome. We hypothesized that in a Scandinavian cohort of ICU patients, APACHE II, SOFA, and simplified acute physiology score (SAPS II) were superior to predict outcome compared with the Child-Pugh score.
  
  
  METHODS
  A single-centre retrospective cohort analysis was conducted in a university-affiliated ICU. Eighty-seven adult patients with decompensated liver alcoholic cirrhosis were admitted from January 2007 to January 2010.
  
  
  RESULTS
  The patients were severely ill with median scores: SAPS II 60, SOFA (day 1) 11, APACHE II 31, and Child-Pugh 12. Receiver operating characteristic curves area under curve was 0.79 for APACHE II, 0.83 for SAPS II, and 0.79 for SOFA (day 1) compared with 0.59 for Child-Pugh. In patients only in need of mechanical ventilation, the 90-day mortality was 76%. If respiratory failure was further complicated by shock treated with vasopressor agents, the 90-day mortality increased to 89%. Ninety-day mortality for patients in need of mechanical ventilation, vasoactive medication, and renal replacement therapy because of acute kidney injury was 93%.
  
  
  CONCLUSIONS
  APACHE II, SAPS II, and SOFA were better at predicting mortality than the Child-Pugh score. With three or more organ failures, the ICU mortality was > 90%. APACHE II > 30, SAPS II > 60, and SOFA at day 1 > 12 were all associated with a mortality of > 90%. Referral criteria of patients suffering from decompensated alcoholic liver disease should be revised.
authors.affiliation: Department of Anesthesia and Intensive Care Medicine, Odense University Hospital, University of Southern Denmark, Denmark.
authors.forename: M
authors.initials: M
authors.lastname: Kavli
authors.forename: T
authors.initials: T
authors.lastname: Strøm
authors.forename: M
authors.initials: M
authors.lastname: Carlsson
authors.forename: B
authors.initials: B
authors.lastname: Dahler-Eriksen
authors.forename: P
authors.initials: P
authors.lastname: Toft
mesh_terms: D018806:APACHE; D000368:Aged; D016638:Critical Illness / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D053208:Kaplan-Meier Estimate; D008104:Liver Cirrhosis, Alcoholic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000175:diagnosis; D011237:Predictive Value of Tests; D012372:ROC Curve; D012121:Respiration, Artificial; D016019:Survival Analysis; D016896:Treatment Outcome; D014662:Vasoconstrictor Agents / Q000627:therapeutic use
chemical_list: D014662:Vasoconstrictor Agents