Abstract

VALIDATION OF LACTATE AND THE SEQUENTIAL ORGAN FAILURE ASSESSMENT SCORE IN THE PREDICTION OF MORTALITY OF THE CRITICALLY ILL CIRRHOTIC PATIENTS.

Magdy El Serafy , Hanan Abd El Hafez *, Mohamed Alshafaey , Hanan Madany ,
Ismail Anwar , Rasha Eletreby

Abstract

Background and Aim: The aim of this study was to determine the efficacy of SOFA score in comparison with liver specific scoring systems (Child-Turcotte-Pugh (CTP) and Model for End-stage Liver Disease (MELD)) in providing a predictive measure of mortality for critically ill cirrhotic patients. Methodology: Forty patients with cirrhosis were admitted to the ICU with varying indications. Informed consents were obtained from the patients’ relatives. Patients were assessed clinically, by laboratory and imaging investigations .Different scorning systems such as CTP , MELD and Sequential Organ Failure Assessment (SOFA) scores were calculated on admission, and 48 hours, together with blood lactate level, measured on admission, at 6, 24 and 48 hours. The results were compared between died and surviving patients in a period of six weeks follow up to explore the significant determinants of ICU mortality for cirrhotic patients. Results: CTP, MELD and SOFA scores were significantly higher in patients who died than in those who survived. SOFA calculated 48 hours after ICU admission was shown to be the best prognostic model, with AUROC of 0.908. SOFA score predicted mortality of 72% if it exceeded 8. SOFA score tested at 48 h of admission also showed significant progression in survivors compared to non survivors in a decreasing manner. Conclusions: In terms of prognostic value, SOFA score is superior to MELD and CTP scores and can be used for prioritization of high risk patients and preservation of ICU resources and its reevaluation after 48 h adds to its prognostic significance.

Keywords: liver cirrhosis, ICU, SOFA score.