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The outcome of critical illness in decompensated alcoholic liver cirrhosis.
- Source :
-
Acta anaesthesiologica Scandinavica [Acta Anaesthesiol Scand] 2012 Sep; Vol. 56 (8), pp. 987-94. Date of Electronic Publication: 2012 Apr 04. - Publication Year :
- 2012
-
Abstract
- Background: The mortality of patients suffering from acute decompensated liver disease treated in the intensive care unit (ICU) varies between 50% and 100%. Previously published data suggest that liver-specific score systems are less accurate compared with the ICU-specific scoring systems acute physiology and chronic health evaluation II (APACHE II) and simplified organ failure assessment (SOFA) in predicting outcome. We hypothesized that in a Scandinavian cohort of ICU patients, APACHE II, SOFA, and simplified acute physiology score (SAPS II) were superior to predict outcome compared with the Child-Pugh score.<br />Methods: A single-centre retrospective cohort analysis was conducted in a university-affiliated ICU. Eighty-seven adult patients with decompensated liver alcoholic cirrhosis were admitted from January 2007 to January 2010.<br />Results: The patients were severely ill with median scores: SAPS II 60, SOFA (day 1) 11, APACHE II 31, and Child-Pugh 12. Receiver operating characteristic curves area under curve was 0.79 for APACHE II, 0.83 for SAPS II, and 0.79 for SOFA (day 1) compared with 0.59 for Child-Pugh. In patients only in need of mechanical ventilation, the 90-day mortality was 76%. If respiratory failure was further complicated by shock treated with vasopressor agents, the 90-day mortality increased to 89%. Ninety-day mortality for patients in need of mechanical ventilation, vasoactive medication, and renal replacement therapy because of acute kidney injury was 93%.<br />Conclusion: APACHE II, SAPS II, and SOFA were better at predicting mortality than the Child-Pugh score. With three or more organ failures, the ICU mortality was > 90%. APACHE II > 30, SAPS II > 60, and SOFA at day 1 > 12 were all associated with a mortality of > 90%. Referral criteria of patients suffering from decompensated alcoholic liver disease should be revised.<br /> (© 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.)
- Subjects :
- APACHE
Aged
Female
Follow-Up Studies
Humans
Kaplan-Meier Estimate
Liver Cirrhosis, Alcoholic mortality
Male
Middle Aged
Multiple Organ Failure diagnosis
Predictive Value of Tests
ROC Curve
Respiration, Artificial
Survival Analysis
Treatment Outcome
Vasoconstrictor Agents therapeutic use
Critical Illness therapy
Liver Cirrhosis, Alcoholic therapy
Subjects
Details
- Language :
- English
- ISSN :
- 1399-6576
- Volume :
- 56
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- Acta anaesthesiologica Scandinavica
- Publication Type :
- Academic Journal
- Accession number :
- 22471740
- Full Text :
- https://doi.org/10.1111/j.1399-6576.2012.02692.x