AP-HP, Hôpital Saint-Antoine, Service de Réanimation Médicale, 75012 Paris, France; UPMC, Université Paris 06, Sorbonne Universités, 75006 Paris, France; INSERM, UMR_S 938, CdR Saint-Antoine, 75012 Paris, France.
Clin Res Hepatol Gastroenterol. 2013 Nov;37(5):455-66. doi: 10.1016/j.clinre.2013.05.001. Epub 2013 Jun 15.
Mortality is increased in cirrhotic patients admitted in ICU whatever the admission reason. Prognosis scores assessed in critically ill cirrhotic patients in ICU can be classified in three main categories: liver-specific (CTP and MELD) scores, general (SAPS II and APACHE) scores, and organ failure (OSF and SOFA) scores. The components of the liver-specific scores can be influenced by the acute disease indicating the admission to ICU but those of the non liver-specific scores can be influenced by the underlying liver cirrhosis. Many studies reported that organ failure scores are the best predictors of outcome in cirrhotic patients in ICU. We may wonder if cirrhotic patients with acute organ failures should receive prioritization for organ allocation to save their life or should be denied for a potential futile LT. According to recent studies, the SOFA score is associated with a higher risk of death for patients waiting for LT but could not be associated with a worse outcome after LT. It becomes of paramount importance to correctly identify the cirrhotic patients who will maximally benefit from LT after admission to ICU. The EASL-CLIF Consortium defines the CLIF-SOFA score, redefining the SOFA score with cut-off levels based on mortality prediction. The CLIF-SOFA could represent the ideal score in ICU since it is based on organ failures with cut-off values specifically identified in cirrhotic patients. The validation of the CLIF-SOFA score in critically ill cirrhotic patients admitted to ICU and its usefulness to identify patients who could benefit from LT should be the next steps.
无论入院原因如何，入住 ICU 的肝硬化患者死亡率均增加。可将 ICU 中重症肝硬化患者的预后评分分为三大类：肝脏特异性评分（CTP 和 MELD）、一般评分（SAPS II 和 APACHE）和器官衰竭评分（OSF 和 SOFA）。肝脏特异性评分的组成部分可能会受到提示入住 ICU 的急性疾病的影响，但非肝脏特异性评分的组成部分可能会受到潜在肝硬化的影响。许多研究报告称，器官衰竭评分是预测 ICU 中肝硬化患者预后的最佳指标。我们可能会想知道，患有急性器官衰竭的肝硬化患者是否应该优先考虑器官分配以挽救生命，或者是否应该拒绝进行潜在的无效 LT。根据最近的研究，SOFA 评分与等待 LT 的患者死亡风险增加相关，但与 LT 后结局较差无关。正确识别入住 ICU 后最能从 LT 中获益的肝硬化患者变得至关重要。EASL-CLIF 联盟定义了 CLIF-SOFA 评分，用基于死亡率预测的截断值重新定义了 SOFA 评分。CLIF-SOFA 可能是 ICU 中的理想评分，因为它基于器官衰竭，其截断值是专门在肝硬化患者中确定的。对入住 ICU 的重症肝硬化患者进行 CLIF-SOFA 评分验证及其识别可能从 LT 中获益的患者的实用性应是下一步。
