Short-term prognosis in critically ill patients with liver cirrhosis: use of the SOFA score

Introduction

In patients with liver cirrhosis who develop extra-hepatic organ failure hospital mortality rates of 63-100% have been reported [1]. For ethical reasons but also due to limited resources physicians need early and reliable outcome predictors to identify cases where aggressive treatment for cure or potential liver transplantation is merited, as well as those where such care is likely futile. We therefore analysed the prognostic accuracy of the Child-Pugh (CP) classification, the Acute Physiology and Chronic Health Evaluation (APACHE) II prognostic system and the Sequential Organ Failure Assessment (SOFA) [2] in predicting hospital mortality of cirrhotic patients on the first day after admission to a medical ICU.

Patients and methods

All patients with hepatic cirrhosis admitted to our medical ICU were eligible. Prospectively collected data included demographics, reason for ICU admission, acute diagnosis and mortality rates. Prognostic data were assessed 24 hours after ICU admission. Discriminative power of the scores was evaluated using the area under the receiver operating characteristic (AUROC) curve.

Results

143 consecutive patients with hepatic cirrhosis were enrolled. 62% were male, median age was 53 years. Hospital mortality was 46%. CP category (A/B/C; n) was 6/40/97, mean CP points 10.1 ± 2, mean APACHE II 20.6 ± 10.7, mean SOFA 8.6 ± 4.7. The total SOFA score on the first ICU day had the best predictive ability (AUROC 0.94, standard error (SE) 0.02). No significant differences were seen between APACHE II (AUROC 0.79, SE 0.04) and CP points (AUROC 0.74, SE 0.04). A cut-off of 8 SOFA points had an overall correctness of 91%, a positive predictive value (PV) of 87% and a negative PV of 96% with regard to hospital mortality.

Conclusion

In our population of critically ill patients with cirrhosis the total SOFA score on the first ICU day was found to be a very reliable scoring system to discriminate between hospital survivors and non-survivors.