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Lactate and Number of Organ Failures Predict Intensive Care Unit Mortality in Patients with Acute-on-Chronic Liver Failure

2019Journal article Open access
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dc.contributor.authorSousa Cardoso, F
dc.contributor.authorAbraldes, J
dc.contributor.authorSy, E
dc.contributor.authorRonco, JJ
dc.contributor.authorBagulho, L
dc.contributor.authorMcphail, M
dc.contributor.authorKarvellas, C
dc.date.accessioned2021-03-19T17:09:37Z
dc.date.available2021-03-19T17:09:37Z
dc.date.issued2019
dc.description.abstractBackground and aims: Patients with acute-on-chronic liver failure (ACLF) have high mortality rates. Most prognostic scores were not developed for the intensive care unit (ICU) setting. We aimed to improve risk stratification for patients with ACLF in the ICU. Methods: A training set with 240 patients with cirrhosis and organ failures (Chronic Liver Failure Sequential Organ Failure Assessment score [CLIF-SOFA]) from Curry Cabral Hospital (Portugal) and University of Alberta Hospital (Canada) in 2010-2016 was used to derive a prognostic model for ICU mortality. A validation set with 237 patients with cirrhosis and organ failures from Vancouver General Hospital (Canada) in 2000-2011 was used to evaluate its performance. Results: Amongst patients in the training set, ICU and hospital mortality rates were 39.2% and 54.6% respectively. Median lactate (4.4 vs 2.5 mmol/L) and number of organ failures (3 vs 2) on admission to ICU were associated with higher likelihood of ICU mortality (P < 0.001 for both). The lactate and organ failures predictive model (LacOF) was derived to predict ICU mortality: -2.420 + 0.072 × lactate + 0.569 × number of organ failures (area under-the-curve [AUC], 0.76). In the validation set, the LacOF model discriminative ability (AUC, 0.85) outperformed the CLIF-SOFA (AUC, 0.79), Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (AUC, 0.73), Model for End-stage Liver Disease score (AUC, 0.78) and Acute Physiology and Chronic Health Evaluation II scores (AUC, 0.74; P < 0.05 for all). The LacOF model calibration was good up to the 25% likelihood of ICU mortality. Conclusions: In patients with ACLF, lactate and number of organ failures on admission to ICU are useful to predict ICU mortality. This early prognostic evaluation may help to better stratify the risk of ICU mortality and thus optimize organ support strategies.pt_PT
dc.description.versioninfo:eu-repo/semantics/publishedVersionpt_PT
dc.identifier.citationLiver Int. 2019 Jul;39(7):1271-1280.pt_PT
dc.identifier.doi10.1111/liv.14083pt_PT
dc.identifier.urihttp://hdl.handle.net/10400.17/3619
dc.language.isoengpt_PT
dc.peerreviewedyespt_PT
dc.publisherWileypt_PT
dc.subjectAcute-On-Chronic Liver Failurept_PT
dc.subjectCalibrationpt_PT
dc.subjectCanadapt_PT
dc.subjectDecision Support Techniquespt_PT
dc.subjectFemalept_PT
dc.subjectHumanspt_PT
dc.subjectIntensive Care Unitspt_PT
dc.subjectLactic Acidpt_PT
dc.subjectLiver Cirrhosispt_PT
dc.subjectMalept_PT
dc.subjectMiddle Agedpt_PT
dc.subjectOrgan Dysfunction Scorespt_PT
dc.subjectPortugalpt_PT
dc.subjectPrognosispt_PT
dc.subjectROC Curvept_PT
dc.subjectRetrospective Studiespt_PT
dc.subjectHospital Mortalitypt_PT
dc.subjectHCC UCIpt_PT
dc.titleLactate and Number of Organ Failures Predict Intensive Care Unit Mortality in Patients with Acute-on-Chronic Liver Failurept_PT
dc.typejournal article
dspace.entity.typePublication
oaire.citation.endPage1280pt_PT
oaire.citation.issue7pt_PT
oaire.citation.startPage1271pt_PT
oaire.citation.titleLiver Internationalpt_PT
oaire.citation.volume39pt_PT
rcaap.rightsopenAccesspt_PT
rcaap.typearticlept_PT

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