Help
Subscribe


GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy

 26 September 2016

Advanced search
GastroHep.com - the global online resource for all aspects of gastroenterology, hepatology and endoscopy Profile of Roy Pounder

Home

News  
Journals
Review Articles
Slide Atlas
Video Clips
Online Books
Advanced Digestive Endoscopy
Classical Cases
Conference Diary
PubMed
International GH Links
USA GH Links
National GH Links
National GI Societies
Other Useful Links




Emails on Gastroenterology and Hepatology
the National AIDS Treatment Advocacy Project
Visit the gastroenterology section of the EUMS

News

Novel prognostic score for patients with cirrhosis admitted to ICU

This month's issue of the American Journal of Gastroenterology reports on a calibrated prognostic model for patients with cirrhosis admitted to the intensive care unit, as compared with current models.

News image

Prognosis for patients with cirrhosis admitted to intensive care unit (ICU) is poor.

ICU prognostic models are more accurate than liver-specific models.

Professor Andrew Burroughs and colleagues from the United Kingdom identified predictors of mortality, and developed a novel prognostic score (Royal Free Hospital (RFH) score).

The team tested the score against established prognostic models, and the yet unvalidated Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) model.

Predictors of mortality were defined by logistic regression in a cohort of 635 consecutive patients with cirrhosis admitted to ICU up to 2012.

The RFH score was derived using a 75% training, and 25% validation set.

Classification accuracy was 77% in a validation sample
American Journal of Gastroenterology

The research team evaluated predictive accuracy and calibration using area under the receiver operating characteristic (AUROC) and goodness-of-fit χ2 for the RFH score, as well as for SOFA, Model for End-Stage Liver Disease (MELD), Acute Physiology and Chronic Health Evaluation (APACHE II), and Child-Pugh.

CLIF-SOFA was applied to a recent subset of patients.

The researchers found that in-hospital mortality was 52%.

Mortality improved over time but with a corresponding reduction in acuity of illness on admission.

Predictors of mortality in training set, which constituted the RFH score, included bilirubin, international normalized ratio, lactate, alveolar arterial partial pressure oxygen gradient, urea, while variceal bleeding as indication for admission conferred lesser risk.

The team observed that classification accuracy was 73% in training, and 77% in a validation sample, and did not change significantly across different eras of admission.

The AUROC for the derived model was 0.83 and the goodness-of-fit χ2 was 3.74.

The researchers noted tAUROC at for SOFA was 0.81, MELD was 0.79, APACHE II was 0.78, and Child-Pugh was 0.67.

In 2005–2012 cohort, AUROC was 0.74 for SOFA, 0.75 for CLIF-SOFA, and 0.78 for RFH.

Goodness-of-fit χ2 was 6.21 for SOFA, 9.18 for CLIF-SOFA, and 2.91 for RFH.

Professor Burroughs' team concludes, "RFH score demonstrated good discriminative ability and calibration."

"Internal validation supports its generalizability."

"CLIF-SOFA did not perform better than RFH and the original SOFA."

"External validation of our model should be undertaken to confirm its clinical utility."

Am J Gastroenterol 2014; 109: 554–562
15 April 2014

Go to top of page Email this page Email this page to a colleague

 26 September 2016 
Preventing cirrhosis in Hep C with fibrosis
 26 September 2016 
Body image after abdominoperineal excision for rectal cancer
 26 September 2016 
Gastric cancer risk in intestinal metaplasia of the stomach
 23 September 2016 
Sleep quality in nonalcoholic cirrhotic patients
 23 September 2016 
Exercise for NAFLD
 23 September 2016 
BMI history and fatty liver
 22 September 2016 
Predicting small-bowel Crohn’s disease
 22 September 2016 
Colectomy outcomes for ulcerative colitis
 22 September 2016 
Technology vs intervention for weight loss
 21 September 2016 
Cardiopulmonary exercise testing in liver transplant candidates
 21 September 2016 
Employment status and IBD
 21 September 2016 
Patients vs providers on nutrition in IBD
 20 September 2016 
Improving healthcare systems for viral Hepatitis
 20 September 2016 
GI benefits of COX-2 selective inhibitors
 20 September 2016 
Predicting relapse in Crohn's
 19 September 2016 
Prevalence of esophageal cancer in Barrett's
 19 September 2016 
Fecal microbiota transplantation and CDI in IBD
 19 September 2016 
Antibiotic resistance in Helicobacter pylori
 16 September 2016 
Low-residue diet before colonoscopy and bowel cleansing
 16 September 2016 
Genome-wide association in gastric cancer
 16 September 2016 
H. pylori in children with asthma
 15 September 2016 
Improving survival in cholangitis-associated septic shock
 15 September 2016 
Colorectal cancer survival and hospital volumes
 15 September 2016 
Primary sclerosing cholangitis and IBD
 14 September 2016 
Intestinal malabsorption and olmesartan
 14 September 2016 
Infection reduction strategy after colorectal resection
 14 September 2016 
Predicting long-term infliximab use in Crohn's
 13 September 2016 
Predicting survival in refractory celiac disease
 13 September 2016 
Cancer risk stratification in Barrett’s
 13 September 2016 
Screening vs non-screening colonoscopy
 12 September 2016 
Screening in familial colorectal cancer
 12 September 2016 
Metformin improves survival in pancreatic ductal cancer
 12 September 2016 
Consent guidelines for GI endoscopy procedures
 09 September 2016 
Development of IBS
 09 September 2016 
Safe and effective treatment for NASH
 09 September 2016 
Scale for stool measurement in diarrhea-IBS
 08 September 2016 
Prognostic factors for infliximab in Crohn's
 08 September 2016 
Chronic Hep B vs chronic Hep C and mortality
 08 September 2016 
Hematological malignancies in IBD
 07 September 2016 
IBD relapse during pregnancy
 07 September 2016 
New treatments for ulcerative colitis
 07 September 2016 
Alternative to nucleic acid testing in HCV
 06 September 2016 
Endoscopy clinic no-shows
 06 September 2016 
Risk of infection after elective colorectal surgery
 06 September 2016 
EHealth technologies in IBD
 05 September 2016 
Esophageal impedance monitoring
 05 September 2016 
Family history and IBD clinical course
 05 September 2016 
Biomarker for IBD and GI cancer
 02 September 2016 
Dietary carbohydrate intake, insulin resistance and GERD 
 02 September 2016 
Postpolypectomy bleeding in the colorectum
 02 September 2016 
Postop recurrence of Crohn's
 01 September 2016 
Prognostic test for liver transplants
 01 September 2016 
Recovery after colorectal surgery in elderly patients
 01 September 2016 
Obesity and post-ERCP pancreatitis
 30 August 2016 
NAFLD and carotid atherosclerosis
 30 August 2016 
Quality improvement program after colorectal surgery
 30 August 2016 
Gut microbial diversity in smokers with Crohn's
 29 August 2016 
Reducing Hep B-related HCC
 29 August 2016 
Hep B immunization of infants for liver cancer
 29 August 2016 
Risk factor for post-ERCP pancreatitis

Blackwell Publishing


GastroHep.com is a Blackwell Publishing registered trademark
© 2016 Wiley-Blackwell and GastroHep.com and contributors
Privacy Statement
Disclaimer
About Us