Gastroenterology and Intensive Care Divisions, Central Lisbon Hospital Center, Curry Cabral Hospital, Lisbon, Portugal.
Gastroenterology Division (Liver Unit), University of Alberta Hospital, Edmonton, AB, Canada.
Liver Int. 2019 Jul;39(7):1271-1280. doi: 10.1111/liv.14083. Epub 2019 Mar 19.
Patients with acute-on-chronic liver failure (ACLF) have high mortality rates. Most prognostic scores were not developed for the intensive care unit (ICU) setting. We aimed to improve risk stratification for patients with ACLF in the ICU.
A training set with 240 patients with cirrhosis and organ failures (Chronic Liver Failure Sequential Organ Failure Assessment score [CLIF-SOFA]) from Curry Cabral Hospital (Portugal) and University of Alberta Hospital (Canada) in 2010-2016 was used to derive a prognostic model for ICU mortality. A validation set with 237 patients with cirrhosis and organ failures from Vancouver General Hospital (Canada) in 2000-2011 was used to evaluate its performance.
Amongst patients in the training set, ICU and hospital mortality rates were 39.2% and 54.6% respectively. Median lactate (4.4 vs 2.5 mmol/L) and number of organ failures (3 vs 2) on admission to ICU were associated with higher likelihood of ICU mortality (P < 0.001 for both). The lactate and organ failures predictive model (LacOF) was derived to predict ICU mortality: -2.420 + 0.072 × lactate + 0.569 × number of organ failures (area under-the-curve [AUC], 0.76). In the validation set, the LacOF model discriminative ability (AUC, 0.85) outperformed the CLIF-SOFA (AUC, 0.79), Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (AUC, 0.73), Model for End-stage Liver Disease score (AUC, 0.78) and Acute Physiology and Chronic Health Evaluation II scores (AUC, 0.74; P < 0.05 for all). The LacOF model calibration was good up to the 25% likelihood of ICU mortality.
In patients with ACLF, lactate and number of organ failures on admission to ICU are useful to predict ICU mortality. This early prognostic evaluation may help to better stratify the risk of ICU mortality and thus optimize organ support strategies.
急性慢性肝衰竭（ACLF）患者死亡率较高。大多数预后评分并非专为重症监护病房（ICU）而开发。我们旨在改善 ICU 中 ACLF 患者的风险分层。
使用 2010 年至 2016 年 Curry Cabral 医院（葡萄牙）和阿尔伯塔大学医院（加拿大）的 240 例肝硬化伴器官衰竭患者（慢性肝脏衰竭序贯器官衰竭评估评分[CLIF-SOFA]）的训练集来推导 ICU 死亡率的预后模型。使用 2000 年至 2011 年温哥华总医院（加拿大）的 237 例肝硬化伴器官衰竭患者的验证集来评估其性能。
在训练集中，ICU 和医院死亡率分别为 39.2%和 54.6%。入住 ICU 时的中位血乳酸（4.4 与 2.5 mmol/L）和器官衰竭数量（3 与 2）与 ICU 死亡率较高相关（均 P<0.001）。乳酸和器官衰竭预测模型（LacOF）用于预测 ICU 死亡率：-2.420+0.072×血乳酸+0.569×器官衰竭数量（曲线下面积[AUC]，0.76）。在验证集中，LacOF 模型的判别能力（AUC，0.85）优于 CLIF-SOFA（AUC，0.79）、慢性肝脏衰竭联盟急性慢性肝衰竭（AUC，0.73）、终末期肝脏疾病评分模型（AUC，0.78）和急性生理学和慢性健康评估 II 评分（AUC，0.74；均 P<0.05）。LacOF 模型的校准在 ICU 死亡率为 25%的情况下良好。
在 ACLF 患者中，入住 ICU 时的血乳酸和器官衰竭数量有助于预测 ICU 死亡率。这种早期预后评估可能有助于更好地分层 ICU 死亡率风险，从而优化器官支持策略。
