집중 치료실에 입실한 비대상성 간경변 환자의 예후 인자 분석 = The Analysis of Prognostic Factors in Patients with Decompensated Liver Cirrhosis Admitted to the Medical Intensive Care Unit

다국어 초록 (Multilingual Abstract)

Background: Patients with decompensated liver cirrhosis usually resulted in admission to the intensive care unit (ICU) during hospitalization. When admitted to the ICU, the mortality was high. The aim of this study is to identify multiple prognostic factors for mortality and to analyze the significance of prognostic survival model with each scoring system in patients with decompensated liver cirrhosis who was admitted to the ICU.
Methods: From January 2008 to December 2008, 60 consecutive patients with decompensated liver cirrhosis were admitted in the ICU and retrospectively reviewed. Prognostic models used were Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), model for end-stage liver disease with incorporation of serum sodium (MELD-Na), acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA). The predictive prognosis was analyzed using the area under the receiver’s operating characteristics curve (AUC).
Results: The median follow up period was 20 months, and ICU mortality was 17% (n = 10). A total of 24 patients (40%) died during the study period. The average survival of five prognostic models was related with the severity of the disease. All of the five systems showed significant differences in the cumulative survival rate, according to the scores on admission, and the MELD-Na had the highest AUC (0.924). Multivariate analysis showed that bilirubin and albumin were significantly related to mortality.
Conclusions: The CPT, MELD, MELD-Na, APACHE II, and SOFA may predict the prognosis of patients with decompensated liver cirrhosis. The MELD-Na could be a better prognostic predictor than other scoring systems.

참고문헌 (Reference)

1 Vincent JL, "The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine" 22 : 707-710, 1996

2 Trotter JF, "Specific laboratory methodologies achieve higher model for endstage liver disease (MELD) scores for patients listed for liver transplantation" 10 : 995-1000, 2004

3 Wehler M, "Short-term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems" 34 : 255-261, 2001

4 Wehler M, "Short-term prognosis in critically ill patients with cirrhosis assessed by prognostic scoring systems" 34 : 255-261, 2001

5 Ferreira FL, "Serial evaluation of the SOFA score to predict outcome in critically ill patients" 286 : 1754-1758, 2001

6 Ferreira FL, "Serial evaluation of the SOFA score to predict outcome in critically ill patients" 286 : 1754-1758, 2001

7 Cholongitas E, "Risk factors, sequential organ failure assessment and model for end-stage liver disease scores for predicting short term mortality in cirrhotic patients admitted to intensive care unit" 23 : 883-893, 2006

8 Cholongitas E, "Prognostic models in cirrhotics admitted to intensive care units better predict outcome when assessed at 48 h after admission" 23 : 1223-1227, 2008

9 Butt AK, "Predicting hospital mortality in cirrhotic patients: comparison of Child-Pugh and Acute Physiology, Age and Chronic Health Evaluation (APACHE III) scoring systems" 93 : 2469-2475, 1998

10 Heuman DM, "Persistent ascites and low serum sodium identify patients with cirrhosis and low MELD scores who are at high risk for early death" 40 : 802-810, 2004

11 Zauner CA, "Outcome prediction for patients with cirrhosis of the liver in a medical ICU: a comparison of the APACHE scores and liver-specific scoringsystems" 22 : 559-563, 1996

12 Singh N, "Outcome of patients with cirrhosis requiring intensive care unit support: prospective assessment of predictors of mortality" 33 : 73-79, 1998

13 Salerno F, "MELD score is better than Child-Pugh score in predicting 3-month survival of patients undergoing transjugular intrahepatic portosystemic shunt" 36 : 494-500, 2002

14 Saab S, "MELD fails to measure quality of life in liver transplant candidates" 11 : 218-223, 2005

15 Zimmerman JE, "Intensive care unit admissions with cirrhosis: risk-stratifying patient groups and predicting individual survival" 23 : 1393-1401, 1996

16 Chemin I, "High incidence of hepatitis B infections among chronic hepatitis cases of unknown aetiology" 34 : 447-454, 2001

17 Biggins SW, "Evidence-based incorporation of serum sodium concentration into MELD" 130 : 1652-1660, 2006

18 Wang YW, "Correlation and comparison of the model for end-stage liver disease, portal pressure, and serum sodium for outcome prediction in patients with liver cirrhosis" 41 : 706-712, 2007

19 Kamath PS, "Advanced Liver Disease Study Group: The model for end-stage liver disease (MELD)" 45 : 797-805, 2007

20 Knaus WA, "APACHE II: a severity of disease classification system" 13 : 818-829, 1985