title: Validation and analysis of prognostic scoring systems for critically ill patients with cirrhosis admitted to ICU.
abstract: BACKGROUND
  The number of patients admitted to ICU who have liver cirrhosis is rising. Current prognostic scoring tools to predict ICU mortality have performed poorly in this group. In previous research from a single centre, a novel scoring tool which modifies the Child-Turcotte Pugh score by adding Lactate concentration, the CTP + L score, is strongly associated with mortality. This study aims to validate the use of the CTP + L scoring tool for predicting ICU mortality in patients admitted to a general ICU with cirrhosis, and to determine significant predictive factors for mortality with this group of patients. This study will also explore the use of the Royal Free Hospital (RFH) score in this cohort.
  
  
  METHODS
  A total of 84 patients admitted to the Glasgow Royal Infirmary ICU between June 2012 and Dec 2013 with cirrhosis were included. An additional cohort of 115 patients was obtained from two ICUs in London (St George's and St Thomas') collected between October 2007 and July 2009. Liver specific and general ICU scoring tools were calculated for both cohorts, and compared using area under the receiver operating characteristic (ROC) curves. Independent predictors of ICU mortality were identified by univariate analysis. Multivariate analysis was utilised to determine the most predictive factors affecting mortality within these patient groups.
  
  
  RESULTS
  Within the Glasgow cohort, independent predictors of ICU mortality were identified as Lactate (p < 0.001), Bilirubin (p = 0.0048), PaO2/FiO2 Ratio (p = 0.032) and PT ratio (p = 0.012). Within the London cohort, independent predictors of ICU mortality were Lactate (p < 0.001), PT ratio (p < 0.001), Bilirubin (p = 0.027), PaO2/FiO2 Ratio (p = 0.0011) and Ascites (p = 0.023). The CTP + L and RFH scoring tools had the highest ROC value in both cohorts examined.
  
  
  CONCLUSIONS
  The CTP + L and RFH scoring tool are validated prognostic scoring tools for predicting ICU mortality in patients admitted to a general ICU with cirrhosis.
authors.affiliation: Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK. 1007950c@student.gla.ac.uk.
authors.forename: Joseph
authors.initials: J
authors.lastname: Campbell
authors.affiliation: Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK. Joanne.mcpeake@glasgow.ac.uk.
authors.forename: Joanne
authors.initials: J
authors.lastname: McPeake
authors.affiliation: Medical Physics, NHS Greater Glasgow and Clyde, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK. Martin.Shaw@nhs.net.
authors.forename: Martin
authors.initials: M
authors.lastname: Shaw
authors.affiliation: Intensive Care Unit, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow, G4 OSF, UK. Alex.puxty@nhs.net.
authors.forename: Alex
authors.initials: A
authors.lastname: Puxty
authors.affiliation: Department of Gastroenterology, NHS Greater Glasgow and Clyde, 84 Castle Street, Glasgow, G4 OSF, UK. Ewan.forrest@ggc.scot.nhs.uk.
authors.forename: Ewan
authors.initials: E
authors.lastname: Forrest
authors.affiliation: Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK. Charlotte.soulsby@glasgow.ac.uk.
authors.forename: Charlotte
authors.initials: C
authors.lastname: Soulsby
authors.affiliation: Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK. 0900192E@student.gla.ac.uk.
authors.forename: Philp
authors.initials: P
authors.lastname: Emerson
authors.affiliation: Clinical lead for Gastroenterology & Hepatology (Worthing), Western Sussex Hospitals NHS Foundation Trust, Worthing, BN11 2DH, UK. Sam.Thomson@wsht.nhs.uk.
authors.forename: Sam J
authors.initials: SJ
authors.lastname: Thomson
authors.affiliation: Department of Gastroenterology & Hepatology, The Prince Charles Hospital, Brisbane, Queensland, Australia. tonyrahman@gmail.com.|College of Medicine & Dentistry, James Cook University, Cairns, Queensland, Australia. tonyrahman@gmail.com.
authors.forename: Tony M
authors.initials: TM
authors.lastname: Rahman
authors.affiliation: Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK. Taraquasim@nhs.net.
authors.forename: Tara
authors.initials: T
authors.lastname: Quasim
authors.affiliation: Academic Unit of Anaesthesia, Pain and Critical Care, University of Glasgow, Room 2.73, Level 2, New Lister Building, Glasgow Royal Infirmary, 10-16 Alexandra Parade, Glasgow, G31 2ER, UK. John.kinsella@glasgow.ac.uk.
authors.forename: John
authors.initials: J
authors.lastname: Kinsella
mesh_terms: D016638:Critical Illness / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007362:Intensive Care Units; D008103:Liver Cirrhosis / Q000150:complications / Q000175:diagnosis* / Q000401:mortality; D008297:Male; D015999:Multivariate Analysis; D011379:Prognosis; D012720:Severity of Illness Index