Prognostic Assessment in Critical Ill Patients with Complications of Liver Cirrhosis Presenting to Emergency Department

Kim, Hoon; Lee, Suk Woo; Chung, Sung Pil

Abstract

PURPOSE
Many patients with cirrhotic complications have been visiting the emergency department (ED). The severity of the malady and the prognosis for the patient are influenced by the degree of hepatic dysfunction. This study was performed to evaluate the prognostic factors for predicting hospital mortality in patients with cirrhosis by comparing the Sequential Organ Failure Assessment (SOFA) score system, the acute physiology and chronic health evaluation (APACHE) II score system, and the modified child-pugh classification score system in the ED.
METHODS
We retrospectively analyzed the medical records of 106 patients with cirrhotic complications who were admitted to the ED of Chungbuk National University Hospital during a 12-month period from June 1, 2003 to May 31, 2003. We classified the complications of cirrhosis as hepatic encephalopathy, upper gastrointestinal bleeding due to varix rupture, and spontaneous bacterial peritonitis. Collected data included the patient 's age and gender, the duration of hosptial stay, the vital signs, the SOFA score, the APACHE II score, and the Modified Child-Pugh classification score at the time of admission to the ED.
RESULTS
The overall predictive accuracy of the SOFA was 5.5% and 10.5% greater than that of the Modified child-pugh classification score system and the APACHE II, respectively. By using the area under receiver operating characteristic (AUROC) curves, the SOFA showed an excellent discriminative power (AUROC 0.875) and the Modified Child-Pugh classification score system (AUROC 0.778) and the APACHE II (AUROC 0.763).
CONCLUSIONS
The SOFA is an easily applied tool with excellent prognostic abilities and can be used to enhance clinical determination of a prognosis and to provide patients and their families with objective information.