Performance of Disease-Specific Scoring Models in Intensive Care Patients with Severe Liver Diseases

Journal Title: Journal of Clinical and Diagnostic Research - Year 2017, Vol 11, Issue 6

Abstract

Introduction: Egypt has the highest prevalence of Hepatitis C Virus (HCV) in the world, estimated nationally at 14.7%. HCV treatment consumes 20% ($80 million) of Egypt’s annual health budget. Outcomes of cirrhotic patients admitted to the ICU may, in fact, largely depend on differences in the state of the disease, criteria and indications for admission, resource utilization, and intensity of treatment. Aim: The aim of the present study was to evaluate the efficacy of liver specific scoring models in predicting the outcome of critically ill cirrhotic patients in the ICU as it may help in prioritization of high risk patients and preservation of ICU resources. Materials and Methods: Over one year, a total of 777 patients with End Stage Liver Disease (ESLD) due to HCV infection were included in this retrospective non-randomized human study. All statistical analyses were performed by the statistical software SPSS version 22.0 (SPSS, Chicago, IL, USA). Child Turcotte Pugh (CTP) score, MELD score, MELD-Na, MESO, iMELD, Refit MELD and Refit MELD-Na were calculated on ICU admission. Results: ICU admission was mainly due to Gastrointestinal (GI) bleeding and Hepatic Encephalopathy (HE). Overall mortality was 27%. Age and sex showed no statistical difference between survivors and non survivors. Significantly higher mean values were observed for all models among individuals who died compared to survivors. MELD-Na was the most specific compared to the other scores. MELD-Na was highly predictive of mortality at an optimized cut-off value of 20.4 (AURC=0.789±0.03-CI 95%=0.711-0.865) while original MELD was highly predictive of mortality at an optimized cut-off value of 17.4 (AURC=0.678±0.01- CI 95%=0.613-0.682) denoting the importance of adding serum sodium to the original MELD. INR, serum creatinine, bilirubin, white blood cells count and hyponatremia were significantly higher in non survivors compared to survivors, while hypoalbuminemia showed no statistical difference. The advent of Hepatorenal Syndrome (HRS) and Spontaneous Bacterial Peritonitis (SBP) carried worse prognosis. Hyponatremia and number of transfused blood bags were additional independent predictors of mortality. Conclusion: In cirrhosis of liver, due to HCV infection, patients who died during their ICU stay displayed significantly higher values on all prognostic scores at admission. The addition of sodium to MELD score greatly improves the predictive accuracy of mortality. MELD-Na showed the highest predictive value of all scores.

Authors and Affiliations

Maged T. EL- Ghannam, Moataz H. Hassanien, Mohamed D. EL- Talkawy, Abdel Aziz A. Saleem, Amal I. Sabry, Hoda M. Abu Taleb

Keywords

Related Articles

A Rare Case of Primary Plasma Cell Leukaemia with Monosomy X

Primary Plasma Cell Leukaemia (pPCL) is a very rare and aggressive subtype of plasma cell dyscrasias with a very poor outcome and characterized by presence of >2x109 /l circulating plasma cells. Overall incidence being 1...

Papillary Renal Cell Carcinoma with Tubercular Paraaortic Lymphadenopathy: A Blessing in Disguise

Incidental Renal Cell Carcinoma (RCC) can be found in a tubercular kidney; however, the vice versa i.e., finding tubercular lymphadenopathy after radical nephrectomy for cancer is exceptionally rare. To the best of our k...

Computed Tomographic Estimation of Relationship between Renal Volume and Body Weight of an Individual

Introduction: Knowledge of normal range of size and volume of abdominal organs plays a vital role in clinical practices as various medical conditions affects the abdominal organs causing alteration in their dimensions. A...

Magnetic Resonance Imaging Evaluation of Central Nervous System Manifestations in Patients Infected with Human Immunodeficiency Virus

Introduction: Involvement of Central Nervous System (CNS) occurs early in Human Immunodeficiency Virus (HIV) infection resulting in significant morbidity and mortality. In these patients, neuroimaging is the modality of...

Histogram Based Synovitis Scoring System Using Ultrasound Images of Rheumatoid Arthritis

ABSTRACT Introduction: The gray scale Ultrasound (US) imaging aids in assessing activity of Rheumatoid arthritis condition through classification of synovitis and is able to estimate the disease progression. The gray sha...

Download PDF file
  • EP ID EP349150
  • DOI 10.7860/JCDR/2017/24543.9980
  • Views 71
  • Downloads 0

How To Cite

Maged T. EL- Ghannam, Moataz H. Hassanien, Mohamed D. EL- Talkawy, Abdel Aziz A. Saleem, Amal I. Sabry, Hoda M. Abu Taleb (2017). Performance of Disease-Specific Scoring Models in Intensive Care Patients with Severe Liver Diseases. Journal of Clinical and Diagnostic Research, 11(6), 12-16. https://www.europub.co.uk/articles/-A-349150