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Researchers find survival increased over time for patients with cirrhosis admitted to ICU

In a retrospective study, researchers found that survival in patients with cirrhosis following admission to an intensive care unit increased over the last decade, and sequential organ failure assessment and chronic liver failure-sequential organ failure assessment scores were similar in predicting patient survival, according to published findings.

Researchers collected and analyzed data from 971 patients with cirrhosis admitted to a liver intensive therapy unit at King’s College Hospital, London, United Kingdom, between January 2000 and December 2010. The median age of the patients was 52 years and 62% were male. Fifty-four percent of the patients had alcohol-associated cirrhosis, 12% had viral cirrhosis and 34% developed cirrhosis due to other causes. Reasons for admission included: multiple organ failure/septic shock (n = 350), gastrointestinal hemorrhage (n = 249), neurologic failure (n = 188), cardiovascular failure (n = 102), isolated renal failure (n = 57) and isolated respiratory failure (n = 25).

While in the hospital, patient survival was compared with illness severity, Acute Physiology and Chronic Health Evaluation (APACHE) II scores, MELD scores, sequential organ failure assessment (SOFA) scores and chronic liver failure-sequential organ failure (CLIF-SOFA) scores.

Overall survival until hospital discharge was 51%, an increase from 40% in 2000 to 63% in 2010 (P < .001). The unadjusted odds ratio for change in mortality per year was 0.87 (95% CI, 0.83-0.91). The APACHE II score adjusted odds ratio for mortality was 0.89 (95% CI, 0.84-0.93).

Of all the scoring systems, the SOFA/CLIF-SOFA score at admission showed an improvement in predicting hospital survival compared with APACHE II or MELD scores. CLIF-SOFA and SOFA scores area under the receiver operating curve (AUROC) values were 0.813 and 0.799, respectively.

“The scores at 48 hours after admission predicted survival with AUROC values of 0.853 and 0.84, and scores after 1 week predicted survival with AUROC values of 0.842 and 0.844, respectively,” the researchers wrote.

The AUROC values were higher among the SOFA and CLIF-SOFA scores compared with AUROC values obtained via APACHE II or MELD scores.

Overall analysis showed that the “etiology of cirrhosis was not associated with a significant difference in survival,” according to the research.

“We have shown that in more than a decade of experience in treating patients with cirrhosis requiring organ support, clinically meaningful and statistically significant improvements in outcome have occurred,” the researchers wrote. “Both the new CLIF-SOFA score and SOFA score on days 1, 3, or 7 appear to be suitable methods for outcome prediction in these patients and this study contributes to early validation of the CLIF SOFA measure. Both systems, however, are limited as indicators of futility.” – by Melinda Stevens

Disclosures: The researchers report no relevant financial disclosures.