Cholongitas E et al. (2008) Prognostic models in cirrhotics admitted to intensive care units better predict outcome when assessed at 48 h after admission. J Gastroenterol Hepatol 23: 1223–1227

Patients with cirrhosis admitted to the intensive care unit (ICU) have a notoriously poor prognosis. Most current prognostic models predict mortality on the basis of data collected during the first 24 h after admission and can perform poorly because they do not adjust for subsequent changes in illness severity or organ function. New research has found that prediction of survival in these patients is improved when prognostic models are applied 48 h after ICU admission.

Cholongitas et al. compared the accuracy of different prognostic models for predicting mortality in 128 patients with cirrhosis. Data were collected on and 48 h after ICU admission; all patients survived for 48 h, but 70 died within the ICU or during 6 weeks of follow-up. Three general models—Acute Physiology and Chronic Health Evaluation II, Sequential Organ Failure Assessment (SOFA), and Failing Organ Systems (FOS)—and two liver-specific models (Child–Turcotte–Pugh, and Model for End-stage Liver Disease) were assessed. The predictive ability of each model was better at 48 h than on admission. Mean scores (the mean of the admission and 48 h scores for individual patients) also had better predictive ability than admission scores. SOFA and FOS scores had the best discriminative ability; a mean SOFA score ≥10 and a mean FOS score ≥1.5 accurately predicted mortality in 91% and 98% of patients, respectively.

While validation of these findings is required, they indicate that mean SOFA and FOS scores over 48 h are valid methods of predicting mortality in acutely ill cirrhotic patients.