title: Increased Survival for Patients With Cirrhosis and Organ Failure in Liver Intensive Care and Validation of the Chronic Liver Failure-Sequential Organ Failure Scoring System.
abstract: OBJECTIVE
  During the past decade, survival has increased among patients admitted to general intensive care units, but it is not clear if it has increased for patients admitted with cirrhosis and organ failure. The chronic liver failure-sequential organ failure assessment (CLIF-SOFA) recently was developed as an adaptation to the SOFA to predict outcomes of patients, but requires validation. We investigated changes in outcomes of patients with cirrhosis and organ failure since 2000, compared the abilities of SOFA and CLIF-SOFA to predict patient survival, and validated the CLIF-SOFA system.
  
  
  METHODS
  In a retrospective study, we collected data from 971 patients (median age, 52 y; age range, 16-90 y; 62% male) with cirrhosis (54% alcohol associated, 12% viral, and 34% other causes). The patients were admitted under emergency conditions from January 1, 2000, to December 31, 2010, to a liver intensive therapy unit in the United Kingdom. Patient survival while in the hospital was compared with measures of illness severity, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, model for end-stage liver disease (MELD) scores, SOFA scores, and CLIF-SOFA scores.
  
  
  RESULTS
  Patients had a median APACHE II score of 21 (range, 5-50) and a median MELD score of 23 (range, 6-40). The median APACHE II score at admission decreased from 23 to 22 over the study period (P < .001), whereas the median MELD score at admission decreased from 23 to 18 (P < .001). Overall survival until hospital discharge was 51%; this value increased from 40% in 2000 to 63% in 2010 (P < .001). The unadjusted odds ratio for change in mortality/year was 0.87 (95% confidence interval, 0.83-0.91; P < .001). The APACHE II score adjusted odds ratio for mortality was 0.89 (95% confidence interval, 0.84-0.93; P < .001). The etiology of cirrhosis was not associated with a significant difference in survival. CLIF-SOFA and SOFA scores at the time of admission predicted patient survival with area under the receiver operating curve (AUROC) values of 0.813 and 0.799, respectively; the scores at 48 hours after admission predicted survival with AUROC values of 0.853 and 0.840, and scores after 1 week predicted survival with AUROC values of 0.842 and 0.844, respectively. These AUROC values were higher than those obtained from APACHE II or MELD scores.
  
  
  CONCLUSIONS
  The proportion of patients with cirrhosis who survived after admission to intensive care increased from 2000 to 2010. SOFA and CLIF-SOFA scores during the first week of critical care appear to have similar abilities to predict patient survival.
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom; Department of Hepatology and Gastroenterology, St Mary's Hospital Campus, Imperial College, London, United Kingdom.
authors.forename: Mark J W
authors.initials: MJ
authors.lastname: McPhail
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
authors.forename: Debbie L
authors.initials: DL
authors.lastname: Shawcross
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
authors.forename: Robin D
authors.initials: RD
authors.lastname: Abeles
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
authors.forename: Anthony
authors.initials: A
authors.lastname: Chang
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
authors.forename: Vishal
authors.initials: V
authors.lastname: Patel
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
authors.forename: Guan-Huei
authors.initials: GH
authors.lastname: Lee
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
authors.forename: Maheeba
authors.initials: M
authors.lastname: Abdulla
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sizer
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
authors.forename: Christopher
authors.initials: C
authors.lastname: Willars
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
authors.forename: Georg
authors.initials: G
authors.lastname: Auzinger
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom.
authors.forename: William
authors.initials: W
authors.lastname: Bernal
authors.affiliation: Institute of Liver Studies, Kings College Hospital, London, United Kingdom. Electronic address: julia.wendon@kcl.ac.uk.
authors.forename: Julia A
authors.initials: JA
authors.lastname: Wendon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003422:Critical Care; D003661:Decision Support Techniques; D005260:Female; D005355:Fibrosis / Q000150:complications* / Q000401:mortality* / Q000473:pathology / Q000628:therapy; D006801:Humans; D017093:Liver Failure / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D016019:Survival Analysis; D006113:United Kingdom; D055815:Young Adult
keywords: Chronic Liver Disease; ICU; Prognosis; Prognostic Factor