title: Factors that predict short-term intensive care unit mortality in patients with cirrhosis.
abstract: OBJECTIVE
  Despite advances in critical care medicine, the mortality rate is high among critically ill patients with cirrhosis. We aimed to identify factors that predict early (7 d) mortality among patients with cirrhosis admitted to the intensive care unit (ICU) and to develop a risk-stratification model.
  
  
  METHODS
  We collected data from patients with cirrhosis admitted to the ICU at Indiana University (IU-ICU) from December 1, 2006, through December 31, 2009 (n = 185), or at the University of Pennsylvania (Penn-ICU) from May 1, 2005, through December 31, 2010 (n = 206). Factors associated with mortality within 7 days of admission (7-d mortality) were determined by logistic regression analyses. A model was constructed based on the predictive parameters available on the first day of ICU admission in the IU-ICU cohort and then validated in the Penn-ICU cohort.
  
  
  RESULTS
  Median Model for End-stage Liver Disease (MELD) scores at ICU admission were 25 in the IU-ICU cohort (interquartile range, 23-34) and 32 in the Penn-ICU cohort (interquartile range, 26-41); corresponding 7-day mortalities were 28.3% and 53.6%, respectively. MELD score (odds ratio, 1.13; 95% confidence interval [CI], 1.07-1.2) and mechanical ventilation (odds ratio, 5.7; 95% CI, 2.3-14.1) were associated independently with 7-day mortality in the IU-ICU. A model based on these 2 variables separated IU-ICU patients into low-, medium-, and high-risk groups; these groups had 7-day mortalities of 9%, 27%, and 74%, respectively (concordance index, 0.80; 95% CI, 0.72-0.87; P < 10(-8)). The model was applied to the Penn-ICU cohort; the low-, medium-, and high-risk groups had 7-day mortalities of 33%, 56%, and 71%, respectively (concordance index, 0.67; 95% CI, 0.59-0.74; P < 10(-4)).
  
  
  CONCLUSIONS
  A model based on MELD score and mechanical ventilation on day 1 can stratify risk of early mortality in patients with cirrhosis admitted to the ICU. More studies are needed to validate this model and to enhance its clinical utility.
authors.affiliation: Division of Gastroenterology and Hepatology, University of Pennsylvania, Philadelphia, Pennsylvania, USA. mghabril@iu.edu
authors.forename: Ranjeeta
authors.initials: R
authors.lastname: Bahirwani
authors.forename: Marwan
authors.initials: M
authors.lastname: Ghabril
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Forde
authors.forename: Hemant
authors.initials: H
authors.lastname: Chatrath
authors.forename: Karen M
authors.initials: KM
authors.lastname: Wolf
authors.forename: Lindsay
authors.initials: L
authors.lastname: Uribe
authors.forename: K Rajender
authors.initials: KR
authors.lastname: Reddy
authors.forename: Barry
authors.initials: B
authors.lastname: Fuchs
authors.forename: Naga
authors.initials: N
authors.lastname: Chalasani
mesh_terms: D000328:Adult; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007196:Indiana; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000401:mortality* / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015233:Models, Statistical; D010414:Pennsylvania; D011379:Prognosis; D012121:Respiration, Artificial; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis
keywords: APACHE; Acute Physiology and Chronic Health Evaluation; CI; Cirrhosis; ICU; IQR; IU; Indiana University; Intensive Care; MELD; Model for End-stage Liver Disease; Mortality; OR; Penn; Predictors; University of Pennsylvania; c-index; concordance index; confidence interval; intensive care unit; interquartile range; odds ratio