Department of Anesthesia and Intensive Care Medicine, Odense University Hospital, University of Southern Denmark, Denmark.
Acta Anaesthesiol Scand. 2012 Sep;56(8):987-94. doi: 10.1111/j.1399-6576.2012.02692.x. Epub 2012 Apr 4.
The mortality of patients suffering from acute decompensated liver disease treated in the intensive care unit (ICU) varies between 50% and 100%. Previously published data suggest that liver-specific score systems are less accurate compared with the ICU-specific scoring systems acute physiology and chronic health evaluation II (APACHE II) and simplified organ failure assessment (SOFA) in predicting outcome. We hypothesized that in a Scandinavian cohort of ICU patients, APACHE II, SOFA, and simplified acute physiology score (SAPS II) were superior to predict outcome compared with the Child-Pugh score.
A single-centre retrospective cohort analysis was conducted in a university-affiliated ICU. Eighty-seven adult patients with decompensated liver alcoholic cirrhosis were admitted from January 2007 to January 2010.
The patients were severely ill with median scores: SAPS II 60, SOFA (day 1) 11, APACHE II 31, and Child-Pugh 12. Receiver operating characteristic curves area under curve was 0.79 for APACHE II, 0.83 for SAPS II, and 0.79 for SOFA (day 1) compared with 0.59 for Child-Pugh. In patients only in need of mechanical ventilation, the 90-day mortality was 76%. If respiratory failure was further complicated by shock treated with vasopressor agents, the 90-day mortality increased to 89%. Ninety-day mortality for patients in need of mechanical ventilation, vasoactive medication, and renal replacement therapy because of acute kidney injury was 93%.
APACHE II, SAPS II, and SOFA were better at predicting mortality than the Child-Pugh score. With three or more organ failures, the ICU mortality was > 90%. APACHE II > 30, SAPS II > 60, and SOFA at day 1 > 12 were all associated with a mortality of > 90%. Referral criteria of patients suffering from decompensated alcoholic liver disease should be revised.
在重症监护病房（ICU）接受治疗的急性失代偿性肝病患者的死亡率在 50%至 100%之间变化。以前发表的数据表明，与 ICU 特定评分系统急性生理学和慢性健康评估 II（APACHE II）和简化的器官衰竭评估（SOFA）相比，肝脏特异性评分系统在预测预后方面准确性较低。我们假设，在斯堪的纳维亚 ICU 患者队列中，APACHE II、SOFA 和简化急性生理学评分（SAPS II）在预测预后方面优于 Child-Pugh 评分。
对一家大学附属医院的 ICU 进行了一项单中心回顾性队列分析。2007 年 1 月至 2010 年 1 月期间，87 名患有失代偿性酒精性肝硬化的成年患者入院。
患者病情严重，中位数评分：SAPS II 60、SOFA（第 1 天）11、APACHE II 31 和 Child-Pugh 12。APACHE II、SAPS II 和 SOFA（第 1 天）的受试者工作特征曲线下面积分别为 0.79、0.83 和 0.79，而 Child-Pugh 为 0.59。仅需要机械通气的患者，90 天死亡率为 76%。如果呼吸衰竭进一步因需要血管加压药物治疗的休克而复杂化，90 天死亡率增加至 89%。需要机械通气、血管活性药物和肾脏替代疗法治疗急性肾损伤的患者，90 天死亡率为 93%。
APACHE II、SAPS II 和 SOFA 比 Child-Pugh 评分更能预测死亡率。有三个或更多器官衰竭的患者，ICU 死亡率>90%。APACHE II>30、SAPS II>60 和第 1 天的 SOFA>12 都与死亡率>90%相关。应修订患有失代偿性酒精性肝病的患者的转诊标准。
