Review article: scoring systems for assessing prognosis in critically ill adult cirrhotics
Article first published online: 12 JUL 2006
Alimentary Pharmacology & Therapeutics
Volume 24, Issue 3, pages 453–464, August 2006
How to Cite
CHOLONGITAS, E., SENZOLO, M., PATCH, D., SHAW, S., HUI, C. and BURROUGHS, A. K. (2006), Review article: scoring systems for assessing prognosis in critically ill adult cirrhotics. Alimentary Pharmacology & Therapeutics, 24: 453–464. doi: 10.1111/j.1365-2036.2006.02998.x
- Issue published online: 12 JUL 2006
- Article first published online: 12 JUL 2006
- Publication data Submitted 9 April 2006 First decision 3 May 2006 Resubmitted 16 May 2006 Accepted 17 May 2006
Cirrhotic patients admitted to intensive care units (ICU) still have poor outcomes. Some current ICU prognostic models [Acute Physiology and Chronic Health Evaluation (APACHE), Organ System Failure (OSF) and Sequential Organ Failure Assessment (SOFA)] were used to stratify cirrhotics into risk categories, but few cirrhotics were included in the original model development. Liver-specific scores [Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD)] could be useful in this setting.
To evaluate whether ICU prognostic models perform better compared with liver-disease specific ones in cirrhotics admitted to ICU.
We performed a structured literature review identifying clinical studies focusing on prognosis and risk factors for mortality in adult cirrhotics admitted to ICU.
We found 21 studies (five solely dealing with gastrointestinal bleeding) published during the last 20 years (54–420 patients in each). APACHE II and III, SOFA and OSF had better discrimination for correctly predicting death compared with the CTP score. The MELD score was evaluated only in one study and had good predictive accuracy [receiver operator characteristic (ROC) curve: 0.81). Organ dysfunction models (OSF, SOFA) were superior compared with APACHE II and III (ROC curve: range 0.83–0.94 vs. 0.66–0.88 respectively). Cardiovascular, liver and renal system dysfunction were more frequently independently associated with mortality.
General-ICU models had better performance in cirrhotic populations compared with CTP score; OSF and SOFA had the best predictive ability. Further prospective and validation studies are needed.