TY - JOUR

T1 - Sepsis-related Organ Failure Assessment Score is a strong predictor of survival in acute-on-chronic liver failure

AU - Cold, Frederik

AU - Schiødt, Frank Vinholt

AU - Pott, Frank Christian

AU - Strandkjær, Nina

AU - Christensen, Erik

N1 - Articles published in the DMJ are “open access”. This means that the articles are distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits any non-commercial use, distribution, and reproduction in any medium, provided the original author(s) and source are credited.

PY - 2019

Y1 - 2019

N2 - INTRODUCTION: The mortality of patients with an exacer-bation of decompensated liver cirrhosis is high even if treated in the intensive care unit (ICU), and the criteria for referral to ICU are not well defined. The objective of this study was to identify variables associated with mortality.METHODS: A single-centre retrospective cohort analysis was conducted in a university-affiliated ICU. A total of 53 adult patients with decompensated alcoholic liver cirrhosis were admitted from January 2012 to June 2015. Variables associated with survival were identified using Cox regression analysis.RESULTS: The ten-day, 30-day, 90-day, and one-year mortality were 36%, 57%, 66%, and 80%, respectively. Univariate Cox regression analysis showed that mortality was significantly associated with a low oxygen saturation, low diastolic blood pressure, terlipressin treatment, high Acute Physiology And Chronic Health Evaluation II score, high Simplified Acute Physiology Score II score, high Sepsis-related Organ Failure Assessment (SOFA) score and high Model For End-Stage Liver Disease score, but only a high SOFA score and old age were independently associated with increased mortality. These two variables were combined to the Age-SOFA index to predict the probability of surviving a given period.CONCLUSIONS: The mortality was high in these severely ill patients, even when they received optimum supportive therapy in the ICU. The finding that the SOFA score and age best predicted mortality shows that the increased mortality was caused mainly by insufficiency of organs other than the liver.FUNDING: none.TRIAL REGISTRATION: not relevant.

AB - INTRODUCTION: The mortality of patients with an exacer-bation of decompensated liver cirrhosis is high even if treated in the intensive care unit (ICU), and the criteria for referral to ICU are not well defined. The objective of this study was to identify variables associated with mortality.METHODS: A single-centre retrospective cohort analysis was conducted in a university-affiliated ICU. A total of 53 adult patients with decompensated alcoholic liver cirrhosis were admitted from January 2012 to June 2015. Variables associated with survival were identified using Cox regression analysis.RESULTS: The ten-day, 30-day, 90-day, and one-year mortality were 36%, 57%, 66%, and 80%, respectively. Univariate Cox regression analysis showed that mortality was significantly associated with a low oxygen saturation, low diastolic blood pressure, terlipressin treatment, high Acute Physiology And Chronic Health Evaluation II score, high Simplified Acute Physiology Score II score, high Sepsis-related Organ Failure Assessment (SOFA) score and high Model For End-Stage Liver Disease score, but only a high SOFA score and old age were independently associated with increased mortality. These two variables were combined to the Age-SOFA index to predict the probability of surviving a given period.CONCLUSIONS: The mortality was high in these severely ill patients, even when they received optimum supportive therapy in the ICU. The finding that the SOFA score and age best predicted mortality shows that the increased mortality was caused mainly by insufficiency of organs other than the liver.FUNDING: none.TRIAL REGISTRATION: not relevant.

KW - Acute-On-Chronic Liver Failure/mortality

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Critical Illness/mortality

KW - Denmark

KW - End Stage Liver Disease

KW - Female

KW - Hospital Mortality

KW - Hospitalization

KW - Humans

KW - Intensive Care Units

KW - Liver Cirrhosis/etiology

KW - Liver Cirrhosis, Alcoholic

KW - Male

KW - Middle Aged

KW - Organ Dysfunction Scores

KW - Prognosis

KW - Proportional Hazards Models

KW - ROC Curve

KW - Retrospective Studies

KW - Sepsis/complications

KW - Time Factors

M3 - Journal article

C2 - 31315795

VL - 66

JO - Danish Medical Journal

JF - Danish Medical Journal

SN - 2245-1919

IS - 8

M1 - A5557

ER -