Retrospective evaluation of prognostic score performances in cirrhotic patients admitted to an intermediate care unit.
BACKGROUND
The prognosis of cirrhotic patients in the Intensive Care Unit requires the development of predictive tools for mortality. We aimed to evaluate the ability of different prognostic scores to predict hospital mortality in these patients.


METHODS
A single-centre retrospective analysis was conducted of 281 hospital stays of cirrhotic patients at an Intermediate Care Unit between June 2009 and December 2010. The performance of the Simplified Acute Physiology Score (SOFA), the Simplified Acute Physiology Score (SAPS) II or III, Child-Pugh, Model for End-Stage Liver Disease (MELD), MELD-Na and the Chronic Liver Failure-Consortium Acute-on-Chronic Liver Failure score (CLIF-C ACLF) in predicting hospital mortality were compared.


RESULTS
Mean age was 58.2±12.1 years; 77% were male. The main cause of admission was acute gastrointestinal bleeding (47%). The in-hospital mortality rate was 25.3%. Receiver operating characteristic curve analyses demonstrated that SOFA (0.82) MELD-Na (0.82) or MELD (0.81) scores at admission predicted in-hospital mortality better than Child-Pugh (0.76), SAPS II (0.77), SAPS III (0.75) or CLIF-C ACLF (0.75). We then developed the cirrhosis prognostic score (Ci-Pro), which performed better (0.89) than SOFA.


CONCLUSIONS
SOFA, MELD and especially the Ci-Pro score show the best performance in predicting hospital mortality of cirrhotic patients admitted to an Intermediate Care Unit.
Caen University Hospital, Department of Hepato-Gastroenterology and Nutrition, Caen, France. Electronic address: benoit-dupont@outlook.com.
Benoît
B
Dupont
Caen University Hospital, Department of Hepato-Gastroenterology and Nutrition, Caen, France. Electronic address: mdelvincourt@gmail.com.
Maxime
M
Delvincourt
Caen University Hospital, Department of Biostatistics and Clinical Research, Caen, France. Electronic address: mamadou.kone@upmc.fr.
Mamadou
M
Koné
Caen University Hospital, Medical Intensive Care, Caen, France. Electronic address: ducheyron-d@chu-caen.fr.
Damien
D
du Cheyron
Caen University Hospital, Department of Hepato-Gastroenterology and Nutrition, Caen, France. Electronic address: ollivierhourmand-i@chu-caen.fr.
Isabelle
I
Ollivier-Hourmand
Caen University Hospital, Department of Hepato-Gastroenterology and Nutrition, Caen, France. Electronic address: piquet-ma@chu-caen.fr.
Marie-Astrid
MA
Piquet
Caen University Hospital, Medical Intensive Care, Caen, France. Electronic address: terzi-n@chu-caen.fr.
Nicolas
N
Terzi
Caen University Hospital, Department of Hepato-Gastroenterology and Nutrition, Caen, France. Electronic address: dao-t@chu-caen.fr.
Thông
T
Dao
D000368:Aged; D001424:Bacterial Infections / Q000382:microbiology / Q000401:mortality; D058625:End Stage Liver Disease / Q000401:mortality*; D005260:Female; D006471:Gastrointestinal Hemorrhage / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012720:Severity of Illness Index
Liver cirrhosis; Mortality; Prognosis