Outcome predictors and new score of critically ill cirrhotic patients with acute renal failure

Ji Tseng Fang, Ming Hung Tsai, Ya Chung Tian, Chang Chyi Jenq, Chan Yu Lin, Yung Chang Chen, Jau Min Lien, Pan Chi Chen, Chih Wei Yang

Research output: Contribution to journalArticlepeer-review

50 Citations (Scopus)

Abstract

Background. End-stage liver disease is often complicated by renal function disturbances. Cirrhotic patients with acute renal failure admitted to intensive care units (ICUs) have high mortality rates. This work seeks to identify specific predictors of hospital mortality in critically ill cirrhotic patients with acute renal failure. Methods. A total of 111 patients with cirrhosis and acute renal failure were admitted to ICU from March 2003 to February 2005. Twenty-six demographic, clinical and laboratory variables were prospectively gathered as predictors of survival on the first day of ICU admission. Results. The overall hospital mortality rate was 81.1%. The univariate analysis identified 11 of the 32 variables as prognostically valuable. The multiple logistic regression analysis (excluding five scoring systems) indicates that the mean arterial pressure (MAP), serum bilirubin, respiratory failure and sepsis on the first day in ICU are significantly related to prognosis. The best Youden index (sensitivity + specificity - 1) yields cutoff points of 80 MAP (in mmHg) and 80 serum bilirubin (in μmol/L) (or 4.7 mg/dL) and indicates acute respiratory failure and sepsis. A simple model for mortality is developed on the basis of these four readily available parameters on Day 1 of ICU admission. The new score (MBRS score: MAP + bilirubin + respiratory failure + sepsis) displays an excellent area under the receiver operating characteristic curve (0.898 ± 0.031, P < 0.001). The mortality rate exceeds 90% when the MBRS (MAP + bilirubin + respiratory failure + sepsis) score is 2 or higher. Conclusion. The MBRS score is a straightforward, reproducible and easily adopted evaluative tool with good prognostic abilities, which generates objective data for patient families and physicians and supplements a clinical judgment of prognosis.

Original languageEnglish
Pages (from-to)1961-1969
Number of pages9
JournalNephrology Dialysis Transplantation
Volume23
Issue number6
DOIs
Publication statusPublished - Jun 2008

Keywords

  • Acute kidney injury
  • APACHE
  • Child - Pugh
  • ICU
  • Prognosis

ASJC Scopus subject areas

  • Nephrology
  • Transplantation

Fingerprint

Dive into the research topics of 'Outcome predictors and new score of critically ill cirrhotic patients with acute renal failure'. Together they form a unique fingerprint.

Cite this