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Model for End-Stage Liver Disease score predicts mortality in critically ill cirrhotic patients.

Publication ,  Journal Article
Boone, MD; Celi, LA; Ho, BG; Pencina, M; Curry, MP; Lior, Y; Talmor, D; Novack, V
Published in: J Crit Care
October 2014

PURPOSE: Cirrhosis is a common condition that complicates the management of patients who require critical care. There is interest in identifying scoring systems that may be used to predict outcome because of the poor odds for recovery despite high-intensity care. We sought to evaluate how Model for End-Stage Liver Disease (MELD), an organ-specific scoring system, compares with other severity of illness scoring systems in predicting short- and long-term mortality for critically ill cirrhotic patients. MATERIALS AND METHODS: This was a retrospective cohort study involving seven intensive care units (ICUs) in a tertiary care, academic medical center. Adult patients with cirrhosis who were admitted to an ICU between 2001 and 2008 were evaluated. Severity of illness scores (MELD and Sequential Organ Failure Assessment [SOFA]) were calculated on admission and at 24 and 48 hours. The primary end points were 28-day and 1-year all-cause mortality. RESULTS: Of 19742 ICU hospitalizations, 848 had cirrhosis. Relevant data were available for 521 patients (73%). Of these cases, 353 patients (69.5%) were admitted to medical ICU (MICU), and the other 155 (30.5%), to surgical unit. Alcohol abuse and hepatitis C were the most common reasons for cirrhosis. Patients who died within 28 days were more likely to receive mechanical ventilation, pressors, and renal replacement therapy. Among 353 medical admissions, both MELD and SOFA were found to be significantly associated with both 28-day and 1-year mortality. Among the 155 surgical admissions, both scores were found to be not significant for 28-day mortality but were significant for 1 year. CONCLUSIONS: Our results demonstrate that the prognostic ability of a variety of scoring systems strongly depends on the patient population. In the MICU population, each model (MELD + SOFA, MELD, and SOFA) demonstrates excellent discrimination for 28-day and 1-year mortality. However, these scoring systems did not predict 28-day mortality in the surgical ICU group but were significant for 1-year mortality. This suggests that patients admitted to a surgical ICU will behave similarly to their MICU cohort if they survive the perioperative period.

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Published In

J Crit Care

DOI

EISSN

1557-8615

Publication Date

October 2014

Volume

29

Issue

5

Start / End Page

881.e7 / 881.13

Location

United States

Related Subject Headings

  • Severity of Illness Index
  • Retrospective Studies
  • Prognosis
  • Organ Dysfunction Scores
  • Middle Aged
  • Male
  • Liver Failure
  • Liver Cirrhosis
  • Intensive Care Units
  • Humans
 

Citation

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Boone, M. D., Celi, L. A., Ho, B. G., Pencina, M., Curry, M. P., Lior, Y., … Novack, V. (2014). Model for End-Stage Liver Disease score predicts mortality in critically ill cirrhotic patients. J Crit Care, 29(5), 881.e7-881.13. https://doi.org/10.1016/j.jcrc.2014.05.013
Boone, M Dustin, Leo A. Celi, Ben G. Ho, Michael Pencina, Michael P. Curry, Yotam Lior, Daniel Talmor, and Victor Novack. “Model for End-Stage Liver Disease score predicts mortality in critically ill cirrhotic patients.J Crit Care 29, no. 5 (October 2014): 881.e7-881.13. https://doi.org/10.1016/j.jcrc.2014.05.013.
Boone MD, Celi LA, Ho BG, Pencina M, Curry MP, Lior Y, et al. Model for End-Stage Liver Disease score predicts mortality in critically ill cirrhotic patients. J Crit Care. 2014 Oct;29(5):881.e7-881.13.
Boone, M. Dustin, et al. “Model for End-Stage Liver Disease score predicts mortality in critically ill cirrhotic patients.J Crit Care, vol. 29, no. 5, Oct. 2014, pp. 881.e7-881.13. Pubmed, doi:10.1016/j.jcrc.2014.05.013.
Boone MD, Celi LA, Ho BG, Pencina M, Curry MP, Lior Y, Talmor D, Novack V. Model for End-Stage Liver Disease score predicts mortality in critically ill cirrhotic patients. J Crit Care. 2014 Oct;29(5):881.e7-881.13.
Journal cover image

Published In

J Crit Care

DOI

EISSN

1557-8615

Publication Date

October 2014

Volume

29

Issue

5

Start / End Page

881.e7 / 881.13

Location

United States

Related Subject Headings

  • Severity of Illness Index
  • Retrospective Studies
  • Prognosis
  • Organ Dysfunction Scores
  • Middle Aged
  • Male
  • Liver Failure
  • Liver Cirrhosis
  • Intensive Care Units
  • Humans