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Organ failure scoring predicts ICU admission for those with cirrhosis, infection

The Quick Sequential Organ Failure Assessment, or qSOFA, scoring system captured the difference in pathophysiology and hemodynamic status of patients with cirrhosis and infections as well as predicted ICU admission, according to a recent study.

“The qSOFA has not been prospectively studied and validated in patients with cirrhosis,” Kavish R. Patidar, DO, from the Virginia Commonwealth University, and colleagues wrote. “Our aim was to prospectively compare qSOFA to other prognostic scoring systems, SIRS [Systemic Inflammatory Response Syndrome] and SOFA [Sequential Organ Failure Assessment], for the prediction of ICU admission, in-hospital mortality, and 30-day mortality in cirrhotic inpatients with and without infections, while controlling for cirrhosis severity.”

The researchers prospectively followed 547 patients with cirrhosis for 30 days using the qSOFA system to assess their condition. The qSOFA consists of three clinical elements: hypotension, altered mentation (below 15 on the Glasgow coma scale) and tachypnea.

Mean patient age was 57 years and mean patient MELD-Na score was 23.8. Overall, 124 patients had infections while 423 did not. The common etiologies for cirrhosis were alcohol (31%) and hepatitis C (24%). Patients with infections had a significantly elevated white blood cell count vs. the uninfected patients (9.25 vs. 7.58; P .001).

Compared with the uninfected patients, patients with infections had higher rates of in-hospital (10% vs. 3%; P = .001) and 30-day mortality (20% vs. 12%; P = .023). Among the patients with infections, the most common reasons for ICU admission included septic shock (33%), respiratory failure (24%), stage 3 or 4 hepatic encephalopathy (15%) and renal failure (15%). Similarly, the most common reasons for ICU admission among the uninfected patients included hemorrhagic shock (45%) respiratory failure (17%) and stage 3 or 4 hepatic encephalopathy (11%).

Using a base risk model designed to compare outcomes with age, sex, MELD-Na, albumin and white blood cell count, the researchers found that qSOFA was the superior predictor for ICU admission (area under the curve = 0.68) in patients with cirrhosis. SIRS, SOFA and qSOFA scores were similar between the patient groups at admission and remained statistically similar after comparing the patients with infections to the base risk model.

“This brief report demonstrates that cirrhotic inpatients admitted without infections have a different pathophysiology and hemodynamic status than infected patients, which can be captured by qSOFA and can predict ICU admission independent of age, [sex], MELD-Na, albumin, and WBC,” the researchers concluded. “However, the currently available clinical markers are insufficient in predicting the same outcome for infected cirrhotic subjects. Further validation is required in a large cohort of infected cirrhotic patients to validate the clinical utility of qSOFA.” – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.