P-36 ACCURACY OF PROGNOSTIC SCORES IN PREDICTION OF MORTALITY IN CIRRHOTIC PATIENTS ADMITTED TO THE INTENSIVE CARE UNIT

Introduction

SAPS-3 and SOFA are prognostic scores commonly employed in intensive care unit (ICU). Their accuracy in prediction of mortality has not been adequately evaluated in comparison to prognostic scores commonly employed cirrhotic patients with acute decompensation (AD) or acute-on-chronic liver failure (ACLF).

Aims

To evaluate the performance of prognostic scores, including SAPS-3, SOFA, CLIF-SOFA, Child-Pugh (CPS), MELD, MELD-Na, CLIF-C organ failure, CLIF-C ACLF, CLIF-C AD scores in the prediction of mortality in unselected patients with cirrhosis admitted to the ICU.

Patients and Methods

213 (150 males, median age 67 [31-91] years) with cirrhosis admitted to the ICU were retrospectively evaluated. All prognostic scores were calculated in the first 24 hours of admission. Their ability to predict mortality was measured using receiver operating characteristic (ROC) curve.

Results

Mortality was observed in 42% of the patients. Analysis of ROC curves revealed that SOFA (0,88) had the best ability to predict mortality, when compared to MELD-Na (0,76), MELD (0,75), CPS (0,71) and SAPS 3 (0,51). In those patients with ACLF, CLIF-ACLF (0,74), CLIF-OF (0,70), MELD-Na (0,73) and MELD (0,69) had a better performance, when compared to SAPS 3 (0,55), SOFA (0,63) and CLIF-SOFA (0,66).

Conclusions

When compared to other general or liver-specific prognostic scores, CLIF-ACLF and SOFA have a better accuracy to predict mortality, respectively, in patients with and without ACLF. SAPS 3 should not be employed as a prognostic score in critically-ill cirrhotic patients.