Risk factors, sequential organ failure assessment and model for end-stage liver disease scores for predicting short term mortality in cirrhotic patients admitted to intensive care unit
Risk factors, sequential organ failure assessment and model for end-stage liver disease scores for predicting short term mortality in cirrhotic patients admitted to intensive care unit
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DOI：
10.1111/j.1365-2036.2006.02842.x
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发表时间：
2006-04-01
影响因子：
7.6
通讯作者：
Burroughs, AK
中科院分区：
文献类型：
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作者：
Cholongitas, E;Senzolo, M;Burroughs, AK
背景预后评分在重症监护室（ICU）评估的结果，但从队列中包含几个alcohol patients.Aim评估6周死亡率alcohol患者入住ICU，并比较一般和肝脏特异性预后scores.Methods共312例连续alcohol患者（65%酒精;平均年龄49.6岁）。多变量logistic回归分析评估与生存相关的入院因素。采用受试者工作特征曲线（ROC曲线）比较Child-Pugh评分、终末期肝病模型（MELD）评分、急性生理学和慢性健康状况评分（APACHE Ⅱ）评分和序贯器官衰竭评分（SOFA）。Child-Pugh、APACHE II、MELD和SOFA评分的中位数（范围）分别为11（5-15）、18（0-44）、24（6-40）和11（0-21）; 65%（n = 203）死亡。生存率随时间推移而改善（P = 0.005）。多变量模型因子：更多器官衰竭（FOS）（< 3 = 49.5%，>= 3 = 90%），较高的FiO（2）、乳酸、尿素和胆红素;导致良好的区分度[受试者工作特征曲线下面积（AUC）= 0.83]，与SOFA和MELD相似（AUC分别为0.83和0.81），上级APACHE Ⅱ和Child-Pugh评分（AUC分别为0.78和0.72）。皇家自由模型区分良好，并包含器官功能的关键变量。SOFA和MELD是比APACHE II或Child-Pugh评分更好的预测因子。
Background Prognostic scores in an intensive care unit (ICU) evaluate outcomes, but derive from cohorts containing few cirrhotic patients.Aim To evaluate 6-week mortality in cirrhotic patients admitted to an ICU, and to compare general and liver-specific prognostic scores.Methods A total of 312 consecutive cirrhotic patients (65% alcoholic; mean age 49.6 years). Multivariable logistic regression to evaluate admission factors associated with survival. Child-Pugh, Model for End-stage Liver Disease (MELD), Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) scores were compared by receiver operating characteristic curves.Results Major indication for admission was respiratory failure (35.6%). Median (range) Child-Pugh, APACHE II, MELD and SOFA scores were 11 (5-15), 18 (0-44), 24 (6-40) and 11 (0-21), respectively; 65% (n = 203) died. Survival improved over time (P = 0.005). Multivariate model factors: more organs failing (FOS) (< 3 = 49.5%, >= 3 = 90%), higher FiO(2), lactate, urea and bilirubin; resulting in good discrimination [area under receiver operating characteristic curve (AUC) = 0.83], similar to SOFA and MELD (AUC = 0.83 and 0.81, respectively) and superior to APACHE II and Child-Pugh (AUC = 0.78 and 0.72, respectively).Conclusions Cirrhotics admitted to ICU with >= 3 failing organ systems have 90% mortality. The Royal Free model discriminated well and contained key variables of organ function. SOFA and MELD were better predictors than APACHE II or Child-Pugh scores.