الفهرس 
LIVER CIRRHOSISOnly 14 pages are availabe for public view
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Abstract
T
he ability to objectively estimate patient risk for mortality or other important outcomes is a new undertaking for clinical research. Empirically based risk assessments for important clinical events have been extremely useful in evaluating new therapies, in monitoring resource utilization, and in improving quality assessment. Attempts at prediction, however, have been much less successful in forecasting individual patient risk or in reducing the uncertainty of daily clinical decision making. Objective risk estimates are particularly important in the high-cost, emotional, and technologically demanding environments of intensive care units (ICUs). Because of the high costs of ICUs, precise quality assurance and utilization management strategies are essential. Knowledge of the risk faced by a patient on the day of ICU admission could provide an empiric basis for quality assurance and utilization activities. Estimates during the course of therapy could be useful in investigating the optimal time for discharge or in deciding how long to continue therapy.
The demand for intensive treatment is growing, but resources are increasingly constrained, and many ICUs are already overcrowded. One half of all the deaths that now occur in ICUs take place only after a decision has been made that further therapy would be futile.
Patients with cirrhosis still have a poor prognosis; such cases lead the list of causes of death in intensive care units (ICU). In treating critically ill cirrhotic patients, objective severity assessment is important in determining therapeutic approach, comparing the benefits of various treatments, assessing new therapeutic procedures, comparing treatment success rates among medical centers and explaining the patient’s condition to the family members.
The aim of our study was to evaluate the usefulness of sequential organ failure assessment (SOFA) and acute physiology, age, chronic health evaluation III (APACHE III) scoring systems obtained on the first day of intensive care unit (ICU) admission in predicting hospital mortality in critically ill cirrhotic patients.
The study enrolled 60 cirrhotic patients consecutively admitted to ICU of TBRI from October 2018 to july2019.
Clinical and laboratory variables were analyzed as predicators of survival. Information considered necessary to calculate the SOFA and APACHE III scores on the first day of ICU admission was also gathered.
The score-matched analytical data showed that the predictive accuracy of SOFA is superior to that of APACHE III in evaluating critically ill patients with cirrhosis.
SOFA score has cut of point ≤9, Sensitivity=96.67,
Specificity=96.67, PPV=96.7 and NPV =96.7
APACHEIII score has cut of point ≤85, Sensitivity=96.67,
Specificity=80, PPV=82.9 and NPV =96.0
The SOFA score is recommended for evaluating long-term prognosis in critically ill patients with cirrhosis.