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News

Factors that predict short-term intensive care unit mortality in cirrhosis

The most recent issue of Clinical Gastroenterology & Hepatology identifies factors that predict short-term intensive care unit mortality in patients with cirrhosis.

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Despite advances in critical care medicine, the mortality rate is high among critically ill patients with cirrhosis.

Dr Ranjeeta Bahirwani and colleagues from Pensylvania, USA identified factors that predict early mortality among patients with cirrhosis admitted to the intensive care unit, and developed a risk-stratification model.

The doctors collected data from patients with cirrhosis admitted to the intensive care unit at Indiana University intensive care unit from 2006, through 2009, or at the University of Pennsylvania intensive care unit from 2005, through 2010.

Factors associated with mortality within 7 days of admission were determined by logistic regression analyses.

A MELD score of 32 at ICU admission had a mortality of 54%
Clinical Gastroenterology and Hepatology

A model was constructed based on the predictive parameters available on the first day of intensive care unit admission in the Indiana University intensive care unit cohort, and then validated in the Penn-intensive care unit cohort.

The researchers found that Model for End-stage Liver Disease scores at intensive care unit admission were 25 in the Indiana University intensive care unit cohort, and 32 in the Penn-intensive care unit cohort.

The team found that corresponding 7-day mortalities were 28%, and 54%, respectively.

Model for End-stage Liver Disease score odds ratio of 1.13 and mechanical ventilation were associated independently with 7-day mortality in the Indiana University intensive care unit.

A model based on these 2 variables separated Indiana University intensive care unit patients into low-, medium-, and high-risk groups.

The team observed that these groups had 7-day mortalities of 9%, 27%, and 74%, respectively.

The team applied the model to the Penn–intensive care unit cohort, and found that the low-, medium-, and high-risk groups had 7-day mortalities of 33%, 56%, and 71%, respectively.

Dr Bahirwani's team concludes, "A model based on Model for End-stage Liver Disease score and mechanical ventilation on day 1 can stratify risk of early mortality in patients with cirrhosis admitted to the intensive care unit."

"More studies are needed to validate this model and to enhance its clinical utility."

Clin Gastroenterol and Hepatol 2013: 11(9): 1194-1200
18 September 2013

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