Document Detail


Outcome predictors and new score of critically ill cirrhotic patients with acute renal failure.
MedLine Citation:
PMID:  18187499     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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 micromol/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.
Authors:
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
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-01-10
Journal Detail:
Title:  Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association     Volume:  23     ISSN:  1460-2385     ISO Abbreviation:  Nephrol. Dial. Transplant.     Publication Date:  2008 Jun 
Date Detail:
Created Date:  2008-05-21     Completed Date:  2008-07-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8706402     Medline TA:  Nephrol Dial Transplant     Country:  England    
Other Details:
Languages:  eng     Pagination:  1961-9     Citation Subset:  IM    
Affiliation:
Department of Nephrology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taipei, Taiwan.
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MeSH Terms
Descriptor/Qualifier:
APACHE
Age Distribution
Aged
Aged, 80 and over
Analysis of Variance
Cause of Death*
Cohort Studies
Comorbidity
Critical Illness / mortality*,  therapy
Female
Hospital Mortality / trends*
Humans
Intensive Care Units
Kaplan-Meiers Estimate
Kidney Failure, Chronic / diagnosis,  mortality*,  therapy
Liver Cirrhosis / diagnosis,  mortality*,  therapy
Male
Middle Aged
Multivariate Analysis
Predictive Value of Tests
Probability
Prognosis
Retrospective Studies
Risk Assessment
Sex Distribution
Statistics, Nonparametric
Survival Analysis

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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