Outcome of critically ill cirrhotic patients: an evaluation of the different scoring systems

ABSTRACT

Several prognostic scoring systems have been designed in an attempt to assess the prognosis of critically ill cirrhotic patients. For this purpose three different prognostic scores [APACHE III score, Child-Pugh score and ICCO score] were studied in intensive care unit, Tropical Medicine and Gastroenterology Department, Assiut University Hospital. A total of 187 cirrhotic patients [149 males, 38 females; age range 15-82 year] were prospectively enrolled in this study. At the time of admission, 73 cases [39%] had bleeding oesophageal varices and 114 cases [61%] had hepatic encephalopathy. Grading of overall severity of liver cirrhosis according to different prognostic scores were done for all studied patients. In patients with hepatic encephalopathy, APACHE III score had the highest positive predictive value [75%] while ICCO score had the highest specificity [89.3%]. On the other hand in critically ill cirrhotic patients with bleeding oesphageal varices APACHE III and ICCO scores had equal positive predictive value [79%] but ICCO score had the highest specificity [92%]. If specificity is considered as a predictor of mortality, ICCO score was found to be the best predictor of mortality in cirrhotic patients who presented with bleeding oesophageal varices and with hepatic encephalopathy followed by APACHE III score. As regards individual laboratory parameters, serum bilirubin was found to be the best single parameter predicting mortality in cirrhotic patients presenting with bleeding oesophageal varices [specificity 90% and sensitivity 89. 74%]. On the other hand plasma lactate was found to be the best laboratory parameter predicting mortality in cirrhotic patients presenting with hepatic encephalopathy [83% positive predictive value and 85% specificity ICCO score was the best predictor of mortality in cirrhotic patients with bleeding oesophageal varices and hepatic encephalopathy followed by APACHE III score. Serum bilirubin was the single laboratory parameter predicting mortality in patients presented with bleeding oesophageal varices. Plasma lactate predicting mortality in who those with hepatic encephalopathy