title: Model for End-Stage Liver Disease score predicts mortality in critically ill cirrhotic patients.
abstract: OBJECTIVE
  Cirrhosis is a common condition that complicates the management of patients who require critical care. There is interest in identifying scoring systems that may be used to predict outcome because of the poor odds for recovery despite high-intensity care. We sought to evaluate how Model for End-Stage Liver Disease (MELD), an organ-specific scoring system, compares with other severity of illness scoring systems in predicting short- and long-term mortality for critically ill cirrhotic patients.
  
  
  METHODS
  This was a retrospective cohort study involving seven intensive care units (ICUs) in a tertiary care, academic medical center. Adult patients with cirrhosis who were admitted to an ICU between 2001 and 2008 were evaluated. Severity of illness scores (MELD and Sequential Organ Failure Assessment [SOFA]) were calculated on admission and at 24 and 48 hours. The primary end points were 28-day and 1-year all-cause mortality.
  
  
  RESULTS
  Of 19742 ICU hospitalizations, 848 had cirrhosis. Relevant data were available for 521 patients (73%). Of these cases, 353 patients (69.5%) were admitted to medical ICU (MICU), and the other 155 (30.5%), to surgical unit. Alcohol abuse and hepatitis C were the most common reasons for cirrhosis. Patients who died within 28 days were more likely to receive mechanical ventilation, pressors, and renal replacement therapy. Among 353 medical admissions, both MELD and SOFA were found to be significantly associated with both 28-day and 1-year mortality. Among the 155 surgical admissions, both scores were found to be not significant for 28-day mortality but were significant for 1 year.
  
  
  CONCLUSIONS
  Our results demonstrate that the prognostic ability of a variety of scoring systems strongly depends on the patient population. In the MICU population, each model (MELD + SOFA, MELD, and SOFA) demonstrates excellent discrimination for 28-day and 1-year mortality. However, these scoring systems did not predict 28-day mortality in the surgical ICU group but were significant for 1-year mortality. This suggests that patients admitted to a surgical ICU will behave similarly to their MICU cohort if they survive the perioperative period.
authors: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA. Electronic address: mboone@bidmc.harvard.edu.
authors: M Dustin
authors: MD
authors: Boone
authors: Department of Pulmonary, Critical Care and Sleep Medicine, Beth Israel Deaconess Medical Center, Boston, MA; Harvard-Massachusetts Institute of Technology Division of Health Science Technology, Cambridge, MA.
authors: Leo A
authors: LA
authors: Celi
authors: Harvard-Massachusetts Institute of Technology Division of Health Science Technology, Cambridge, MA.
authors: Ben G
authors: BG
authors: Ho
authors: Department of Biostatistics, School of Public Health, Boston University, Boston, MA.
authors: Michael
authors: M
authors: Pencina
authors: Department of Medicine, Division of Hepatology, Beth Israel Deaconess Medical Center, and Harvard Medical School, Boston, MA.
authors: Michael P
authors: MP
authors: Curry
authors: Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
authors: Yotam
authors: Y
authors: Lior
authors: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA.
authors: Daniel
authors: D
authors: Talmor
authors: Department of Anesthesia, Critical Care and Pain Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA; Clinical Research Center, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Be'er Sheva, Israel.
authors: Victor
authors: V
authors: Novack
mesh_terms: D000328:Adult; D000368:Aged; D002423:Cause of Death; D016638:Critical Illness; D005260:Female; D006801:Humans; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000209:etiology / Q000401:mortality*; D017093:Liver Failure / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index
keywords: Cirrhosis; Critical care; Epidemiology; Organ dysfunction scores; Outcome; Prognosis