INTENSIVE-CARE UNIT ADMISSIONS WITH CIRRHOSIS - RISK-STRATIFYING PATIENT GROUPS AND PREDICTING INDIVIDUAL SURVIVAL

Prognosis for acutely ill patients with cirrhosis is influenced by the severity of hepatic abnormalities and by dysfunction of other organ s ystems. The purpose of this study was to examine the usefulness of the Acute Physiology, Age, and Chronic Health Evaluation (APACHE III) pro gnostic system for risk-stratifying groups of intensive care unit (ICU ) patients with cirrhosis and in predicting individual survival. We us ed data for 17,440 ICU admissions at 40 American hospitals to select 1 17 of the 537 patients with a history of cirrhosis who were ventilated on ICU day 1, a group known to have a high mortality rate. We then ca lculated each patient's probability of hospital death on ICU days 1 th rough 7, using seven previously validated multivariate equations. Hosp ital mortality was 63% for the 117 study patients. The most important determinants of risk for hospital death on ICU day 1 were the acute ph ysiology score of APACHE III, ICU admission diagnosis, and operative s tatus. Daily changes in the acute physiology score caused a rise or fa ll in the probability of hospital mortality and was useful in assessin g individual response to therapy. APACHE III accurately risk stratifie s critically ill patients with cirrhosis because it accounts for many of the factors known to influence prognosis. This capability can be us ed to assess severity of illness and risk-stratify patients with cirrh osis during clinical trials. Daily prognostic estimates based on physi ological changes over time reflect patient response and can help physi cians to assess the incremental benefit of therapy.