The utility of scoring systems in critically ill patients with cirrhosis admitted to a general ICU

Emerson, P., McPeake, J. , O'Neill, A., Gilmour, H., Forrest, E. and Kinsella, J. (2013) The utility of scoring systems in critically ill patients with cirrhosis admitted to a general ICU. Critical Care Medicine, 41(12), A184-A185. (doi: 10.1097/01.ccm.0000439983.09121.d6)

Abstract

Liver disease is a serious public health issue. Cirrhosis related ICU admissions increased dramatically over the last decade. These patients have a poor prognosis and accurate prognostic scoring tools could help determine those patients who would benefit from ICU admission. There is remarkably little evidence regarding the utility of these scores within a non-transplant setting, despite this being where many critically ill cirrhotic patients are treated. Methods: This was a 12 month, single centred prospective cohort study performed in a general, non-transplant Scottish ICU. 40 clinical and demographic variables were collected on admission to allow the calculation of eight prospective scoring tools. Patients were followed up to obtain ICU and in-hospital mortality. ROC curve analysis was used to determine the accuracy of the scores. Multivariate analysis was used to identify any independent predictors of mortality in these patients. Results: 59 patients were recruited into the study, with an ICU mortality of 31%. All scores other than the renal specific AKIN score performed to a similar degree of accuracy, producing area under the curves (AUC) of between 0.70 and 0.76 - although none reached the clinically useful level of 0.8. The SOFA score was the best performing score. Lactate and ascites were individual predictors of ICU mortality with statistically significant odds ratios of 1.69 and 5.91 respectively. When lactate was incorporated into the Child-Pugh score, its prognostic accuracy increased to a clinically applicable level (AUC 0.86). Conclusions: This investigation suggests that current prognostic scoring tools should be used with caution when assessing critically ill patients with cirrhosis admitted to a general ICU. This study suggests that this group of patients should be assessed on an individual basis for admission to the ICU, and that serum arterial lactate levels may play a role in improving the decision making process of these vulnerable patients.

• Item Type: Articles
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Kinsella, Professor John and Gilmour, Mr Harper and O'Neill, Dr Anna and Forrest, Dr Ewan and McPeake, Dr Jo
• Authors: Emerson, P., McPeake, J., O'Neill, A., Gilmour, H., Forrest, E., and Kinsella, J.
• Subjects: R Medicine > RT Nursing
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care ; College of Science and Engineering > School of Mathematics and Statistics > Statistics
• Journal Name: Critical Care Medicine
• Publisher: Lippincott, Williams and Wilkins
• ISSN: 0090-3493
• ISSN (Online): 1530-0293