'Predicting hospital mortality in cirrhotic patients: Comparison of Child-Pugh and acute physiology, age and chronic health evaluation (APACHE III) scoring systems

Objective: The severity of hepatic abnormalities and extent of dysfunction of other organ systems influences prognosis for cirrhosis. The Child-Pugh s ystem has been used to classify cirrhotic patients into good, intermediate, or poor risk categories in evaluation and therapy. Disregard for cardiores piratory, renal, electrolyte balance, and acid base status limits its predi ctive accuracy. We evaluated the accuracy of Acute Physiology and Chronic H ealth Evaluation (APACHE III) to predict short term hospital mortality in p atients with liver cirrhosis. Methods: A total of 282 patients were prospec tively enrolled. Child-Pugh and APACHE III scores were recorded on day 1 fo r each patient. Results: Mean age was 51.7 +/- 11.3 yr, with 65% men and 35 % women; 57% presented with upper GI bleeding, 47% encephalopathy, 9% hepat orenal syndrome, and 7% hepatocellular carcinoma. Sixty-three patients (22% ) died. Major causes of death were upper GI bleeding 38%, liver failure 21% , hepatorenal syndrome 19%, hepatocellular carcinoma 4%, and spontaneous ba cterial peritonitis 6%. Child-Pugh and APACHE III scores for survivors (8.6 +/- 2.3 and 58.9 +/- 35.1) were lower than those for nonsurvivors (10.9 +/ - 2.7 and 87.4 +/- 30.3) (p < 0.001). Using discriminant analysis, APACHE I II correctly identified 75% of cases vs 67% of cases for Child-Pugh (p < 0. 05). When information regarding ascites and prothrombin time was added to A PACHE HI, 81% of cases were correctly classified. Conclusion: The APACHE II I scoring system is superior to Child-Pugh for prognosticating short term s urvival of cirrhotic patients. Prognostic accuracy of APACHE III can be enh anced by incorporating information regarding ascites and prothrombin time p rolongation. (C) 1998 by Am. Coll. of Gastroenterology.