Luxenburger Hendrik, Schmidt Katharina, Biever Paul, Supady Alexander, Sekandarzad Asieb, Roehlen Natascha, Reincke Marlene, Neumann-Haefelin Christoph, Schultheiss Michael, Wengenmayer Tobias, Thimme Robert, Bettinger Dominik
Department of Medicine II, Medical Center University of Freiburg, Faculty of Medicine, University of Freiburg, Freiburg im Breisgau, Germany.
IMM-PACT, Medizinische Fakultät, Albert-Ludwigs-Universität Freiburg, Freiburg im Breisgau, Germany.
Front Med (Lausanne). 2022 Dec 22;9:1042674. doi: 10.3389/fmed.2022.1042674. eCollection 2022.
Liver cirrhosis in patients treated in the intensive care unit (ICU) is associated with high mortality. Well established scores are useful to allow for assessment of prognosis and support ICU treatment guidance. However, currently used scoring systems often do not reflect the complexity of critically ill patients. Therefore, we tested the newly developed Freiburg index-of post-TIPS survival (FIPS) score in order to assess its potential role for prognostication of cirrhotic patients in the ICU.
A total of 310 patients with liver cirrhosis treated in the ICU between 2010 and 2021 were enrolled in this retrospective observational study. Prognostic factors for mortality and 28-day mortality were assessed. Moreover, using c indices the prognostic discrimination of different prognostic scores was analyzed.
The FIPS score allowed to discriminate patients with high ICU mortality and within 28-days after ICU treatment (ICU mortality: 42.2 vs. 59.9%, = 0.008 and 28-day mortality: 43.3 vs. 74.1%, < 0.001). However, the FIPS score in its current composition showed no superior prognostic discrimination compared to other established scores. Multivariable analyses identified the FIPS score (HR 1.25 [1.04-1.49], = 0.015) and lactate at admission (HR 1.07 [1.04-1.09], < 0.001) as significant predictors of ICU mortality. Lactate at admission substantially improved patient risk stratification within each FIPS risk groups.
Similar to other commonly used scores, the FIPS score in its current composition does not allow a sufficiently reliable prognostication of critically ill patients treated in the ICU. However, adding lactate as additional factor to the FIPS score may improve its prognostic ability.
在重症监护病房（ICU）接受治疗的肝硬化患者死亡率很高。成熟的评分系统有助于评估预后并为ICU治疗指导提供支持。然而，目前使用的评分系统往往无法反映危重症患者的复杂性。因此，我们测试了新开发的弗赖堡经颈静脉肝内门体分流术后生存指数（FIPS）评分，以评估其在ICU肝硬化患者预后评估中的潜在作用。
本回顾性观察研究纳入了2010年至2021年间在ICU接受治疗的310例肝硬化患者。评估了死亡率和28天死亡率的预后因素。此外，使用c指数分析了不同预后评分的预后判别能力。
FIPS评分能够区分ICU死亡率高的患者以及ICU治疗后28天内的患者（ICU死亡率：42.2%对59.9%，P = 0.008；28天死亡率：43.3%对74.1%，P < 0.001）。然而，与其他既定评分相比，当前构成的FIPS评分在预后判别方面并无优势。多变量分析确定FIPS评分（HR 1.25 [1.04 - 1.49]，P = 0.015）和入院时乳酸水平（HR 1.07 [1.04 - 1.09]，P < 0.001）是ICU死亡率的显著预测因素。入院时的乳酸水平在每个FIPS风险组中显著改善了患者风险分层。
与其他常用评分类似，当前构成的FIPS评分无法对在ICU接受治疗的危重症患者进行足够可靠的预后评估。然而，将乳酸作为FIPS评分的额外因素可能会提高其预后能力。
