Performance of disease-specific scoring models in intensive care patients with severe liver diseases

Theodor Bilharz Research Institute

Bibliographic Information

Authors: El-Ghannam M.T.; Hassanien M.H.; El-Talkawy M.D.; Saleem A.A.A.; Sabry A.I.; Abu Taleb H.M.

Journal: Journal of Clinical and Diagnostic Research

Publisher: Journal of Clinical and Diagnostic Research

Publication Date: 2017

Volume / Issue: Volume 11 / Issue 6

Pages: OC12–OC16

ISSN: 2249782X

DOI: 10.7860/JCDR/2017/24543.9980

Scopus: View on Scopus

Document Type: Article

Access: All Open Access; Gold Open Access; Green Open Access

Authors and Affiliations

El-Ghannam M.T., Department of Hepatogastroenterology, Theodor Bilharz Research Institute (TBRI), Giza, Egypt; Hassanien M.H., Department of Hepatogastroenterology, Theodor Bilharz Research Institute (TBRI), Giza, Egypt; El-Talkawy M.D., Department of Hepatogastroenterology, Theodor Bilharz Research Institute (TBRI), Giza, Egypt; Saleem A.A.A., Department of Hepatogastroenterology, Theodor Bilharz Research Institute (TBRI), Giza, Egypt; Sabry A.I., Department of Intensive Care, Theodor Bilharz Research Institute (TBRI), Giza, Egypt; Abu Taleb H.M., Department of Biostatistics, Theodor Bilharz Research Institute (TBRI), Giza, Egypt

Abstract

Introduction: Egypt has the highest prevalence of Hepatitis C Virus (HCV) in the world, estimated nationally at 14.7%. HCV treatment consumes 20% ($80 million) of Egypt’s annual health budget. Outcomes of cirrhotic patients admitted to the ICU may, in fact, largely depend on differences in the state of the disease, criteria and indications for admission, resource utilization, and intensity of treatment. Aim: The aim of the present study was to evaluate the efficacy of liver specific scoring models in predicting the outcome of critically ill cirrhotic patients in the ICU as it may help in prioritization of high risk patients and preservation of ICU resources. Materials and Methods: Over one year, a total of 777 patients with End Stage Liver Disease (ESLD) due to HCV infection were included in this retrospective non-randomized human study. All statistical analyses were performed by the statistical software SPSS version 22.0 (SPSS, Chicago, IL, USA). Child Turcotte Pugh (CTP) score, MELD score, MELD-Na, MESO, iMELD, Refit MELD and Refit MELD-Na were calculated on ICU admission. Results: ICU admission was mainly due to Gastrointestinal (GI) bleeding and Hepatic Encephalopathy (HE). Overall mortality was 27%. Age and sex showed no statistical difference between survivors and non survivors. Significantly higher mean values were observed for all models among individuals who died compared to survivors. MELD-Na was the most specific compared to the other scores. MELD-Na was highly predictive of mortality at an optimized cut-off value of 20.4 (AURC=0.789±0.03-CI 95%=0.711-0.865) while original MELD was highly predictive of mortality at an optimized cut-off value of 17.4 (AURC=0.678±0.01-CI 95%=0.613-0.682) denoting the importance of adding serum sodium to the original MELD. INR, serum creatinine, bilirubin, white blood cells count and hyponatremia were significantly higher in non survivors compared to survivors, while hypoalbuminemia showed no statistical difference. The advent of Hepatorenal Syndrome (HRS) and Spontaneous Bacterial Peritonitis (SBP) carried worse prognosis. Hyponatremia and number of transfused blood bags were additional independent predictors of mortality. Conclusion: In cirrhosis of liver, due to HCV infection, patients who died during their ICU stay displayed significantly higher values on all prognostic scores at admission. The addition of sodium to MELD score greatly improves the predictive accuracy of mortality. MELD-Na showed the highest predictive value of all scores. © 2017, Journal of Clinical and Diagnostic Research. All rights reserved.

Keywords

Cirrhosis; End stage liver disease; HCV infection; Liver specific scoring models; MELD-Na; alanine aminotransferase; albumin; aspartate aminotransferase; bilirubin; creatinine; sodium; adult; aged; Article; bacterial peritonitis; cardiovascular infection; chest infection; Child Pugh score; chronic kidney failure; controlled study; critically ill patient; diabetes mellitus; female; gastrointestinal endoscopy; hepatitis C; high risk patient; human; hypertension; intensive care; leukocyte count; major clinical study; male; Model For End Stage Liver Disease Score; Model for End Stage Liver Disease serum sodium incorporation; Model for End Stage Liver Disease to sodium index; mortality; predictive value; Refit Model for End Stage Liver Disease; retrospective study; scoring system; survivor

Citation Information

Scopus Citations: 3

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