title: Prognosis of cirrhotic patients admitted to the general ICU.
abstract: BACKGROUND
  The prognosis of cirrhotic patients admitted to the ICU is considered to be poor but has been mainly reported in liver ICU. We aimed to describe the prognosis of cirrhotic patients admitted to a general ICU, to assess the predictors of mortality in this population, and, finally, to identify a subgroup of patients in whom intensive care escalation might be discussed.
  
  
  RESULTS
  We performed a retrospective monocentric study of all cirrhotic patients consecutively admitted between 2002 and 2014 in a general ICU in a regional university hospital. Two hundred and eighteen cirrhotic patients were admitted to the ICU. The 28-day and 6-month mortality rates were 53 and 74 %, respectively. Among the 115 patients who were discharged from ICU, only eight patients underwent liver transplantation, whereas 48 had no clear contraindication. Multivariable analyses on 28-day mortality identified three independent variables, incorporated into a new three-variable prognostic model as follows: SOFA ≥ 12 (OR 4.2 [2.2-8.0]; 2 points), INR ≥ 2.6 (OR 2.5 [1.3-4.8]; 1 point), and renal replacement therapy (OR 2.3 [1.1-5.1]; 1 point). For a value of the score at 4 (16 % of patients), 28-day and 3-month mortality rates were 91 and 100 %, respectively. An external validation of the score among 149 critically ill cirrhotic patients showed a good accuracy for predicting in-ICU mortality.
  
  
  CONCLUSIONS
  Mortality of cirrhotic patients admitted to a general ICU was comparable to that of other studies. A pragmatic score integrating the SOFA score, INR, and the need for extrarenal epuration was strongly associated with mortality. Among the 16 % of patients presenting with score 4 at ICU admission, 100 % died in the 3-month follow-up period. The prognostic evaluation on day 3 remains essential for the majority of patients. However, this score calculable at ICU admission might identify patients in whom the benefit of intensive care escalation should be discussed, in particular when liver transplantation is contraindicated.
authors.affiliation: Intensive Care Unit, Besançon University Hospital, 25030, Besançon, France. gpiton@chu-besancon.fr.|Université de Franche Comté, 25000, Besançon, France. gpiton@chu-besancon.fr.
authors.forename: Gaël
authors.identifier: http://orcid.org/0000-0001-7092-9323
authors.initials: G
authors.lastname: Piton
authors.affiliation: Intensive Care Unit, Besançon University Hospital, 25030, Besançon, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Chaignat
authors.affiliation: Intensive Care Unit, Rouen University Hospital, Rouen, France.
authors.forename: Mikhael
authors.initials: M
authors.lastname: Giabicani
authors.affiliation: Hepatology Unit, Besançon University Hospital, Besançon, France.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Cervoni
authors.affiliation: Intensive Care Unit, Rouen University Hospital, Rouen, France.
authors.forename: Fabienne
authors.initials: F
authors.lastname: Tamion
authors.affiliation: Intensive Care and Anesthesiology Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, 75018, Paris, France.|University Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Weiss
authors.affiliation: Intensive Care and Anesthesiology Department, AP-HP, Hôpital Beaujon, Hôpitaux Universitaires Paris Nord Val de Seine, 75018, Paris, France.|University Paris Diderot, Sorbonne Paris Cité, 75018, Paris, France.
authors.forename: Catherine
authors.initials: C
authors.lastname: Paugam-Burtz
authors.affiliation: Intensive Care Unit, Besançon University Hospital, 25030, Besançon, France.|Université de Franche Comté, 25000, Besançon, France.
authors.forename: Gilles
authors.initials: G
authors.lastname: Capellier
authors.affiliation: Université de Franche Comté, 25000, Besançon, France.|Hepatology Unit, Besançon University Hospital, Besançon, France.
authors.forename: Vincent
authors.initials: V
authors.lastname: Di Martino