The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit

Emerson, P., McPeake, J. , O'Neill, A., Gilmour, H., Forrest, E., Puxty, A., Kinsella, J. and Shaw, M. (2014) The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit. Journal of Critical Care, 29(6), 1131.e1-1131.e6. (doi: 10.1016/j.jcrc.2014.06.027)

Abstract

Purpose: This study aimed to establish which prognostic scoring tool provides the greatest discriminative ability when assessing critically ill cirrhotic patients in a general intensive care unit (ICU) setting.<p></p> Methods: This was a 12-month, single-centered prospective cohort study performed in a general, nontransplant ICU. Forty clinical and demographic variables were collected on admission to calculate 8 prospective scoring tools. Patients were followed up to obtain ICU and inhospital mortality. Receiver operating characteristic curve analysis was used to determine the discriminative ability of the scores. Univariate and multivariate analyses were used to identify any independent predictors of mortality in these patients. The incorporation of any significant variables into the scoring tools was assessed.<p></p> Results: Fifty-nine cirrhotic patients were admitted over the study period, with an ICU mortality of 31%. All scores other than the renal-specific Acute Kidney Injury Network score had similar discriminative abilities, producing area under the curves of between 0.70 and 0.76. None reached the clinically applicable level of 0.8. The Sequential Organ Failure Assessment 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 (area under the curve, 0.86).<p></p> Conclusions: This investigation suggests that established prognostic scoring systems should be used with caution when applied to the general, nontransplant ICU as compared to specialist centers. Our data suggest that serum arterial lactate may improve the prognostic ability of these scores.

• Item Type: Articles
• Additional Information: NOTICE: this is the author’s version of a work that was accepted for publication in Journal of Critical Care. Changes resulting from the publishing process, such as peer review, editing, corrections, structural formatting, and other quality control mechanisms may not be reflected in this document. Changes may have been made to this work since it was submitted for publication. A definitive version was subsequently published in Journal of Critical Care, [29, 6, (2014)] http://dx.doi.org/10.1016/j.jcrc.2014.06.027
• 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 Shaw, Dr Martin and McPeake, Dr Jo
• Authors: Emerson, P., McPeake, J., O'Neill, A., Gilmour, H., Forrest, E., Puxty, A., Kinsella, J., and Shaw, M.
• Subjects: R Medicine > R Medicine (General); R Medicine > RT Nursing
• College/School: College of Medical Veterinary and Life Sciences > School of Medicine, Dentistry & Nursing > Nursing and Health Care
• Journal Name: Journal of Critical Care
• Publisher: WB Saunders
• ISSN: 0883-9441
• ISSN (Online): 1557-8615
• Copyright Holders: Copyright © 2014 Elsevier Inc.
• First Published: First published in Journal of Critical Care 29(6):1131.e1–1131.e6
• Publisher Policy: Reproduced in accordance with the copyright policy of the publisher