Outcome of patients with liver cirrhosis admitted to a specialty liver intensive care unit in India

• Published in: Journal of critical care Vol. 24; no. 3; pp. 387 - 393
• Main Authors: Juneja, Deven, DNB, Gopal, Palepu B., MD, FRCA, Kapoor, Dharmesh, MD, DM, Raya, Ravichandra, MD, Sathyanarayanan, Mohan, MD, FRCA, Malhotra, Parveen, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.09.2009; Elsevier Limited
• Subjects: Accuracy; Acute Kidney Injury - complications; Adult; Age Factors; APACHE; APACHE II score; Comorbidity; Critical Care; Critical Illness; Hospital Mortality; Hospitals; Humans; India - epidemiology; Intensive care; Intensive Care Units - statistics & numerical data; Liver cirrhosis; Liver Cirrhosis - complications; Liver Cirrhosis - mortality; Liver Cirrhosis - therapy; Liver diseases; Middle Aged; Mortality; Older people; Prognosis; Prospective Studies; Respiration, Artificial - statistics & numerical data; ROC Curve; Sex Factors; SOFA score; Statistical analysis; Treatment Outcome; Variables; Ventilation; India; Critical care; APACHE II score; SOFA score; Liver cirrhosis
• ISSN: 0883-9441; 1557-8615
• DOI: 10.1016/j.jcrc.2008.12.013

Abstract Purpose The study aimed to describe the clinical outcome of patients with liver cirrhosis admitted to intensive care unit (ICU) and to compare the performance of Acute Physiology and Chronic Health Evaluation (APACHE) II and Sequential Organ Failure Assessment (SOFA) in predicting mortality. Methods In this prospective study of patients with cirrhosis admitted to the ICU, demographic data, APACHE II score, SOFA score, presence of acute renal failure (ARF), need for organ support, and mortality were collected. Results The observed mortality in ICU and at 30 days among 104 patients was 42.3% (95% confidence interval [CI], 32.7%-52.0%) and 56.7% (95% CI, 47.0%-66.4%), respectively. Area under the receiver operating characteristic curve for first-day APACHE II in predicting 30-day mortality was 0.90 (95% CI, 0.83-0.96) and 0.93 (95% CI, 0.88-0.98) for SOFA score ( P = .24). On multivariate analysis, ARF (adjusted odds ratio, 7.7; 95% CI, 1.09-54.64) and mechanical ventilation (adjusted odds ratio, 277.6; 95% CI, 12.83-6004.94) were significantly associated with mortality. Conclusions Presence of ARF and need for mechanical ventilation are associated with high mortality in patients with liver cirrhosis admitted to the ICU. Acute Physiology and Chronic Health Evaluation II and SOFA are good prognostic models in predicting 30-day mortality and do not differ in performance.