Outcome Prediction for Critically Ill Egyptian Cirrhotic Patients in Liver Intensive Care Unit
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- Category: Vol. 85, June 2017
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Outcome Prediction for Critically Ill Egyptian Cirrhotic Patients in Liver Intensive Care Unit, AMANY ABDEL-MAQSOD, HEBA SEDRAC, MERVAT NAGUIB and NOUMAN ELGAREM
Abstract
Background: Decompensation in patients with chronic liver disease leading to hospitalization, usually develops after an acute insult such as variceal bleeding, hepatorenal syndrome, or spontaneous bacterial peritonitis. Mortality rates among cirrhotic patients admitted to intensive care units are high. Prediction of prognosis in critically ill cirrhotic patients helps in prioritizing ICU admission especially with limited resources.
Objective: Comparing the predictive value of Child Tur-cotte-Pugh (CTP), Model for End-Stage Liver Disease (MELD), acute physiology, age, chronic health evaluation II (APACHEII) scores in critically ill cirrhotic patients.
Patients and Methods: This study retrospectively reviewed the medical records of 301 patients who had been admitted to hepatic ICU in a tertiary care hospital from July 2007 to March 2012. The CTP, MELD and APACHE II scores were computed for each patient within the first 24 hours of admis-sion. Patients were classified as either survivors or non survivors. ROC (receiver operator characteristic curve) was used to find out the best cut off and validity of each scoring system for prediction of mortality.
Results: Survivors 129 (42.9%) had significantly lower CTP, MELD and APACHEII scores (10.2±1.9, 21.8±6.8, 22.7±4.5) compared to non survivors (11.3±1.4, 31.4±8.9, 26.6±5.2) p<0.001. MELD score had the highest sensitivity (86.6%) compared to CTP (75.6%) and APACH II (72%). The predictive accuracy of MELD score was the highest (AUC = 0.81) compared to CTP and APACHII scores (AUC = 0.67, 0.71) respectively.
Need for vasopressors and mechanical ventilation were associated with higher mortality (OR 9.9; 95% CI 1.9-50.8) for the former and (OR 8; 95% CI 2.6-24.5)for the later.
Conclusion: In critically ill cirrhotic patients MELD score had the highest sensitivity and predictive accuracy for mortality. In addition, need for mechanical ventilation or vasopressors were associated with poor outcome.