title: Acute circulatory failure-chronic liver failure-sequential organ failure assessment score: a novel scoring model for mortality risk prediction in critically ill cirrhotic patients with acute circulatory failure.
abstract: OBJECTIVE
  Acute circulatory failure (ACF) is associated with high mortality rates in critically ill cirrhotic patients. Only a few accurate scoring models exist specific to critically ill cirrhotic patients with acute circulatory failure (CICCF) for mortality risk assessment. The aim was to develop and evaluate a novel model specific to CICCF.
  
  
  METHODS
  This study collected and analyzed the data on CICCF from the Multiparameter Intelligent Monitoring in Intensive Care-III database. The acute circulatory failure-chronic liver failure-sequential organ failure assessment (ACF-CLIF-SOFA) score was derived by Cox's proportional hazards regression. Performance analysis of ACF-CLIF-SOFA against CLIF-SOFA and model for end-stage liver disease systems was completed using area under the receiver operating characteristic curve.
  
  
  RESULTS
  ACF-CLIF-SOFA identified six independent factors: mean arterial pressure [hazard ratio (HR)=0.984, 95% confidence interval (CI): 0.978-0.990, P<0.001], vasopressin (HR=1.548, 95% CI: 1.273-1.883, P<0.001), temperature (HR=0.764, 95% CI: 0.694-0.840, P<0.001), bilirubin (HR=1.031, 95% CI: 1.022-1.041, P<0.001), lactate (HR=1.113, 95% CI: 1.084-1.142, P<0.001), and urine output (HR=0.854, 95% CI: 0.767-0.951, P=0.004). ACF-CLIF-SOFA showed a better predictive performance than CLIF-SOFA and model for end-stage liver disease in terms of predicting mortality (0.769 vs. 0.729 vs. 0.713 at 30 days, 0.757 vs. 0.707 vs. 0.698 at 90 days, 0.733 vs. 0.685 vs. 0.691 at 1 year, respectively, all P<0.05).
  
  
  CONCLUSIONS
  ACF-CLIF-SOFA, as the first model specific to CICCF, enables a more accurate prediction at 30-day, 90-day, and 1-year follow-up periods than other existing scoring systems.
authors.affiliation: Departments of aCardiovascular Medicine, The Heart Center bGastroenterology cEndocrinology dHepatology, Liver Research Center, The First Affiliated Hospital of Wenzhou Medical University eInstitute of Hepatology, Wenzhou Medical University, Wenzhou fDepartment of Critical Care Medicine, Chinese People's Liberation Army General Hospital, Beijing, China gDepartment of Anesthesiology, Intensive Care, Emergency Medicine and Pain Therapy, Ziekenhuis Oost-Limburg, Genk, Belgium.
authors.forename: Xiao-Dong
authors.initials: XD
authors.lastname: Zhou
authors.forename: Qin-Fen
authors.initials: QF
authors.lastname: Chen
authors.forename: Zheng-Xian
authors.initials: ZX
authors.lastname: Wang
authors.forename: Wen-Yue
authors.initials: WY
authors.lastname: Liu
authors.forename: Sven
authors.initials: S
authors.lastname: Van Poucke
authors.forename: Zhi
authors.initials: Z
authors.lastname: Mao
authors.forename: Sheng-Jie
authors.initials: SJ
authors.lastname: Wu
authors.forename: Wei-Jian
authors.initials: WJ
authors.lastname: Huang
authors.forename: Ming-Hua
authors.initials: MH
authors.lastname: Zheng
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D016208:Databases, Factual; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008103:Liver Cirrhosis / Q000150:complications* / Q000401:mortality; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D008875:Middle Aged; D009102:Multiple Organ Failure / Q000209:etiology* / Q000401:mortality; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012769:Shock / Q000209:etiology* / Q000401:mortality