Outcome prediction for patients with cirrhosis of the liver in a medical ICU: A comparison of the APACHE scores and liver-specific scoring systems

Objective: To find the most adequate prognostic scoring system for predicting ICU-outcome in patients with decompensated liver cirrhosis in a medical intensive care unit (ICU). Design: Retrospective analysis of patients' records over a 10-year period. Setting: A medical ICU at the university medical center of Vienna. Patients and participants: 94% (n = 198) of all patients with cirrhosis admitted to our medical ICU throughout the 10-year study period. Interventions: None. Measurements and results: From data obtained at admission and at 48 h after admission, scores were calculated using the following scoring systems: Acute Physiology and Chronic Health Evaluation (APACHE) II and III, Scale for Composite Clinical and Laboratory Index Scoring (CCLI), Mayo Risk Score, and Child's Classification. Statistical analysis for the prognostic variables was performed using the chi-square test, t-test, Youden index, and area under a receiver operating characteristic (ROC) curve. APACHE III was found to be the most reliable outcome predictor at admission and after 48 h for patients with decompensated liver cirrhosis (AUG = 0.75 and 0.8, respectively). Conclusions: To predict the outcome for patients with decompensated cirrhosis of the liver admitted to a medical ICU liver failure alone is not decisive. Liver-specific scoring systems (Mayo Risk Score, CCLI) are adequate, but the APACHE II and III proved to be more powerful, because they include additional physiologic parameters and therefore also take into account additional complications associated with this liver disorder.