The utility of scoring systems in critically ill cirrhotic patients admitted to a general intensive care unit |
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Authors: | Philip Emerson,Joanne McPeake,Anna O&rsquo Neill,Harper Gilmour,Ewan Forrest,Alex Puxty,John Kinsella,Martin Shaw |
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Affiliation: | 1. University of Glasgow Medical School, Glasgow, G12 8QQ, UK;2. Academic Unit of Anaesthesia, Pain and Critical Care Medicine, University of Glasgow, School of Medicine, Royal Infirmary, Glasgow, UK;3. Nursing and Healthcare School, School of Medicine, University of Glasgow, Glasgow, G12 8LL, UK;4. Medical Statistics, School of Mathematics and Statistics, College of Science and Engineering, University of Glasgow, Glasgow, G12 8QW, UK;5. Glasgow Royal Infirmary, Castle Street, Glasgow, G4 0SF, UK;6. Department of Clinical Physics, University of Glasgow, Glasgow, UK |
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Abstract: | PurposeThis study aimed to establish which prognostic scoring tool provides the greatest discriminative ability when assessing critically ill cirrhotic patients in a general intensive care unit (ICU) setting.MethodsThis was a 12-month, single-centered prospective cohort study performed in a general, nontransplant ICU. Forty clinical and demographic variables were collected on admission to calculate 8 prospective scoring tools. Patients were followed up to obtain ICU and inhospital mortality. Receiver operating characteristic curve analysis was used to determine the discriminative ability of the scores. Univariate and multivariate analyses were used to identify any independent predictors of mortality in these patients. The incorporation of any significant variables into the scoring tools was assessed.ResultsFifty-nine cirrhotic patients were admitted over the study period, with an ICU mortality of 31%. All scores other than the renal-specific Acute Kidney Injury Network score had similar discriminative abilities, producing area under the curves of between 0.70 and 0.76. None reached the clinically applicable level of 0.8. The Sequential Organ Failure Assessment score was the best performing score.Lactate and ascites were individual predictors of ICU mortality with statistically significant odds ratios of 1.69 and 5.91, respectively. When lactate was incorporated into the Child-Pugh score, its prognostic accuracy increased to a clinically applicable level (area under the curve, 0.86).ConclusionsThis investigation suggests that established prognostic scoring systems should be used with caution when applied to the general, nontransplant ICU as compared to specialist centers. Our data suggest that serum arterial lactate may improve the prognostic ability of these scores. |
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Keywords: | Critical care Cirrhosis Scoring tools ICU outcomes |
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