Abstract

FREIRE, Paulo et al. The Cirrhotic Patient in the Intensive Care Unit: Evaluation of the Prognosis. J Port Gastrenterol. [online]. 2011, vol.18, n.2, pp.73-80. ISSN 0872-8178.

INTRODUCTION: Cirrhotic patients admitted in Intensive Care Units (ICU) have a poor prognosis. The prognosis of these patients can be evaluated with general scores (SOFA, APACHE, SAPS) or with specific scoring systems for liver disease (MELD, Child-Pugh). AIMS: To evaluate the prognostic value of general scores (SOFA, APACHE and SAPS) and of liver-specific scores (MELD and Child-Pugh) in patients with liver cirrhosis admitted to general ICUs or to Gastroenterology Intensive Care Units (GICU). MATERIAL AND METHODS: The authors present a literature review on the assessment of the prognosis of cirrhotic patients admitted to ICUs and also report your experience on this issue in the context of a specialized GICU including the analysis of 124 admissions. RESULTS: In several studies on patients with liver cirrhosis admitted to general ICUs, both general and liver-specific scores showed good discrimination, with an area under receiver operating characteristic curve (>AUC) > 0.7. Considering the six most representative studies, the mean value of AUC on SOFA, APACHE II, APACHE III, MELD and Child-Pugh scores was 0.86, 0.74, 0.81, 0.79 and 0.77, respectively. The study of 124 consecutive cirrhotic admissions to a GICU showed that patients who died belonged exclusively to the class C of Child-Pugh and had average values of SOFA, APACHE II, SAPS II and MELD scores significantly higher than those of the patients who survived (10.1, 22.0, 47.5 and 30.7 in those who died and 3.5, 13.6, 25.3 and 18.0 in those who survived, respectively; p < 0.05). CONCLUSIONS: Both general scores and liver-specific scores have prognostic value in the risk assessment of patients with liver cirrhosis admitted to general ICUs or to GICUs. In the ICUs the general scores, and particularly the SOFA score, have better prognostic ability than the liver-specific scores.

Keywords : Liver cirrhosis; intensive care units; prognostic scores.

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