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Comparison of SOFA score to king's criteria and MELD score in the prognosis of acetaminophen-induced acute liver failure.
MedLine Citation:
PMID:  22213443     Owner:  NLM     Status:  Publisher    
Acetaminophen-induced acute liver failure (ALF) is a complex multi organ illness. Assessment of prognosis is essential for accurate identification of patients in whom survival without liver transplantation (LT) is unlikely. The aim of the study was to compare prognostic models (King's, MELD, SOFA and APACHE II) and to identify independent prognostic indicators of outcome. We evaluated consecutive patients with severe acetaminophen-induced ALF admitted to our intensive care unit. At admission, demographic, clinical data and laboratory parameters were recorded. The discriminative ability of each prognostic score at baseline was evaluated by using the area under a receiver operating characteristic (AUROC) curve. In addition we assessed independent factors associated with outcome by multiple logistic regression. In total, 125 consecutive patients with acetaminophen-induced ALF were evaluated: 67 patients (54%) - (group 1) survived with conservative medical management, and 58 (46%) (group 2) either died without liver transplantation (LT) (28%) or underwent LT (18%). Group 1 patients vs group 2, had significantly lower median APACHE II (10 vs 14) and SOFA scores (9 vs 12) (p<0.001). The independent indicators associated with death or LT were higher prothrombin time (p=0.007), FiO2 (p=0.005) and lactate at 12 hours (p<0.0001). The King's criteria had the highest specificity (0.83) but lowest sensitivity (0.47) and SOFA score had the best discriminative ability (AUROC 0.79). In conclusion, in acetaminophen ALF, the SOFA score had better performance, compared to the other prognostic scores, reflecting the presence of multi-organ dysfunction. Further evaluation of SOFA with the King's score is warranted. Liver Transpl, 2011. © 2011 AASLD.
Evangelos Cholongitas; Eleni Theocharidou; Panayota Vasianopoulou; Alex Betrosian; Steve Shaw; David Patch; James O'Beirne; Banwari Agarwal; Andrew K Burroughs
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-12-23
Journal Detail:
Title:  Liver transplantation : official publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society     Volume:  -     ISSN:  1527-6473     ISO Abbreviation:  -     Publication Date:  2011 Dec 
Date Detail:
Created Date:  2012-1-3     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100909185     Medline TA:  Liver Transpl     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2011 American Association for the Study of Liver Diseases.
4th Department of Internal Medicine, Medical School of Aristotle University, Hippokration General Hospital of Thessaloniki, Greece; Liver Transplantation and Hepatobiliary Unit, Pond Street, Hampstead, London NW3 2QG, UK, Royal Free Hospital, London.
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