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Short‐term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems
Author(s) -
Wehler Markus,
Kokoska Judith,
Reulbach Udo,
Hahn Eckhart Georg,
Strauss Richard
Publication year - 2001
Publication title -
hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.488
H-Index - 361
eISSN - 1527-3350
pISSN - 0270-9139
DOI - 10.1053/jhep.2001.26522
Subject(s) - medicine , receiver operating characteristic , sofa score , cirrhosis , intensive care unit , apache ii , workload , intensive care medicine , emergency medicine , computer science , operating system
The short‐term prognosis of acutely ill patients with cirrhosis is influenced by the degree of hepatic insufficiency and by dysfunction of extrahepatic organ systems. The purpose of this study was to assess and compare the prognostic accuracy of the Child‐Pugh classification, the Acute Physiology and Chronic Health Evaluation (APACHE) II system and the Sequential Organ Failure Assessment (SOFA) for predicting hospital mortality in patients with cirrhosis when used 24 hours after admission to a medical intensive care unit (ICU). Prospective data were recorded on 143 patients. Cumulative mortality rates were 36% in the ICU, 46% in the hospital, and 56% at 6‐month follow‐up. By using the area under receiver operating characteristic (AUROC) curves, the SOFA showed an excellent discriminative power (AUROC 0.94), which was clearly superior to the APACHE II (AUROC 0.79) and the Child‐Pugh system (AUROC 0.74). Hospital mortality rates below and above a cutoff of 8 SOFA points were 4% and 88%, respectively ( P < .0005). The SOFA score also reflected resource use during the ICU treatment as measured by daily workload and length of stay. The SOFA is an easily applied tool with excellent prognostic abilities and can be used to enhance clinical judgment of prognosis as well as providing patients and families with objective information.