Prognostication of critically ill patients with acute-on-chronic liver failure using the Chronic Liver Failure-Sequential Organ Failure Assessment: A Canadian retrospective study

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• 作者：Eric Sy ; MD ; FRCPC^a ; ^b ; ^c ; ^{eric.julian.sy@gmail.com" class="auth_mail" title="E-mail the corresponding author} ; Juan J. Ronco ; MD ; FRCPC^c ; Rowan Searle ; MBBS ; MSc^c ; Constantine J. Karvellas ; MD ; SM ; FRCPC^d ; ^e ; ^f ; ^g
• 关键词：ACLF ; acute-on-chronic liver failure ; APACHE ; Acute Physiology and Chronic Health Evaluation ; AUROC ; area under receiver operating curve ; CI ; confidence interval ; CLIF-SOFA ; Chronic Liver Failure&ndash ; Sequential Organ Failure Assessment ; CTP ; Child-Turcotte-Pugh ; Fio2 ; fraction of inspired oxygen ; GCS ; Glasgow Coma Scale ; ICU ; intensive care unit ; IQR ; interquartile range ; MELD ; model for end-stage liver disease ; RFH ; Royal Free Hospital ; SD ; standard deviation ; SOFA ; Sequential Organ Failure A
• 刊名：Journal of Critical Care
• 出版年：2016
• 出版时间：December 2016
• 年：2016
• 卷：36
• 期：Complete
• 页码：234-239
• 全文大小：282 K

文摘

We evaluated the Chronic Liver Failure–Sequential Organ Failure Assessment (CLIF-SOFA) score to predict survival in a Canadian critically ill cohort with acute-on-chronic liver failure.

Methods

We retrospectively examined 274 acute-on-chronic liver failure patients admitted to a quaternary level intensive care unit (ICU) between April 1, 2000, and April 30, 2011. We evaluated severity of illness scores, including the Acute Physiology and Chronic Health Evaluation (APACHE) II, model for end-stage liver disease (MELD), Child-Turcotte-Pugh (CTP), SOFA, and CLIF-SOFA.

Results

On ICU admission, patients had the following median (interquartile range): APACHE II, 23 (19-28); MELD, 26 (19-35); CTP, 12 (10-13); SOFA, 15 (11-18); and CLIF-SOFA, 17 (13-21). In-hospital survival was 40%. There were no significant differences in survival for cirrhosis etiology, reason, or year of admission. The CLIF-SOFA score had the greatest area under receiver operating curve of 0.865 (95% confidence interval, 0.820-0.909) and outperformed the CTP, MELD, SOFA, and APACHE II scores. Sequential Organ Failure Assessment score performance improved on the third day of ICU admission (area under receiver operating curve, 0.935; 95% confidence interval, 0.895-0.975).

Conclusions

The CLIF-SOFA and SOFA scores during the first 3 days of ICU admission appear to be highly predictive of in-hospital mortality.