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SOFA and MELD predicts intensive care mortality in cirrhosis

Mortality in intensive care with cirrhosis is high, and the latest Alimentary Pharmacology & Therapeutics shows that the Model for End-stage Liver Disease predicts the risk better than Acute Physiology and Chronic Health Evaluation II or Child-Pugh scores.

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Prognostic scores in an intensive care unit evaluate outcomes, but derive from cohorts containing few cirrhotic patients.

Professor Burroughs and colleagues from England evaluated 6-week mortality in cirrhotic patients admitted to an intensive care unit.

The investigative team compared general and liver-specific prognostic scores.

A total of 312 consecutive cirrhotic patients, of which 65% were alcoholic with a mean age of 50 years.

The investigators used 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 scores were assessed.

In addition, the team evaluated the Sequential Organ Failure Assessment (SOFA) scores.

The various scores were compared by receiver operating characteristic curves.

Cirrhotics in intensive care with 3 or more failing organ systems have 90% mortality
Alimentary Pharmacology & Therapeutics

The investigators found that the major indication for admission was respiratory failure, in 36%.

Median Child-Pugh, and Acute Physiology and Chronic Health Evaluation II scores were 11 and 18.

The team noted that Model for End-stage Liver Disease and Sequential Organ Failure Assessment scores were 24 and 11, respectively.

The investigators observed that 65% of patients died.

Survival improved over time.

Multivariate model factors included more organs failing, higher FiO2, lactate, urea and bilirubin.

The team found that these factors resulted in good discrimination.

This was similar to Sequential Organ Failure Assessment and Model for End-stage Liver Disease.

In addition, the team noted that it was superior to Acute Physiology and Chronic Health Evaluation II and Child-Pugh scores.

Professor Burroughs' team concluded, “Cirrhotics admitted to intensive care with 3 or more failing organ systems have 90% mortality.”

“The Royal Free model discriminated well and contained key variables of organ function.”

“Sequential Organ Failure Assessment and Model for End-stage Liver Disease were better predictors than Acute Physiology and Chronic Health Evaluation II or Child-Pugh scores.”

Aliment Pharmacol Ther 2006: 23(7): 883
24 March 2006

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