The researchers investigated the short-term prognosis in critically ill patients with cirrhosis, assessed by prognostic scoring systems.
They reported their findings in the August issue of Hepatology.
The prognostic accuracy of 3 different scoring systems were assessed and compared. These were the Child-Pugh classification, the Acute Physiology and Chronic Health Evaluation (APACHE) II system and the Sequential Organ Failure Assessment (SOFA).
Each was used to predict hospital mortality in patients with cirrhosis when used 24 hours after admission to a medical intensive care unit (ICU).
Prospective data were recorded on 143 patients.
Cumulative mortality rates were 36% in the ICU, 46% in the hospital, and 56% at 6-month follow-up.
|Properties of SOFA for cirrhosis patients:|
- Excellent discriminative power
- Score reflects ICU resource use.
The researchers used the areas under receiver operating characteristic (AUROC) curves to assess the discriminative power of the systems. SOFA showed an excellent discriminative power (AUROC 0.94), which was clearly superior to the APACHE II (AUROC 0.79) and the Child-Pugh system (AUROC 0.74).
Hospital mortality rates below and above a cutoff of 8 SOFA points were 4% and 88%, respectively.
The SOFA score was also found to reflect resource use during the ICU treatment, as measured by daily workload and length of stay.
Markus Wehler, of the University of Erlangen-Nuremberg, concluded on behalf of his colleagues, "The SOFA is an easily applied tool with excellent prognostic abilities.
"It can be used to enhance clinical judgment of prognosis, as well as providing patients and families with objective information."