PIRO-CIC model can predict mortality and futility of care in critically ill cirrhosis patients in the intensive care unit.
Hepatol Int
; 17(2): 476-487, 2023 Apr.
Article
em En
| MEDLINE
| ID: mdl-36227516
ABSTRACT
BACKGROUND:
Dynamic assessment of critically ill patients with cirrhosis (CICs) is required for accurate prognostication.OBJECTIVE:
Development of a dynamic model for prediction of mortality and decision on futility of care in CICs. DESIGN ANDSETTING:
In a prospective cohort study, we developed the PIRO-CIC model (predisposition, injury, response, organ failure for critically ill cirrhotics)] in a derivative cohort (n = 360) and validated it (n = 240) for patients admitted to the Liver ICU. PATIENTS Decompensated cirrhosis admitted to ICU. The model was developed using Cox-regression analysis, and futility was performed by decision-curve analysis.RESULTS:
CICs aged 48 ± 11.5 years, 87% males, majority being alcoholics, were enrolled, of which 73.5% were alive at one month. Factors significant for P component were INR [hazard ratio 1.12, 95% confidence interval 1.07-1.18] and CystatinC [2.25, 1.70-2.97]; for I component were sepsis [4.69, 1.90-11.57], arterial lactate[1.40, 1.02-1.93] and alcohol as etiology [2.78, 1.85-4.18]; for R component-systemic inflammatory response syndrome [1.97, 1.14-3.42] and urine neutrophil-gelatinase-associated lipocalin [HR 2.37, 1.59-3.53]; for O component-low PaO2/FiO2 ratio and need of mechanical ventilation [7.41, 4.63-11.86]. The PIRO-CIC model predicted one-month mortality with a C-index of 0.83 in the derivation and 0.80 in the validation cohorts. It predicted futility of care better than other prognostic scores. The immediate risk of mortality increased by 39% with each unit increase in PIRO-CIC score.LIMITATIONS:
Not applicable for acute-on-chronic liver failure and patients requiring emergency liver transplant.CONCLUSIONS:
Assessment and stratification of CICs with the dynamic PIRO-CIC model could determine one-month mortality and futility in the first week. Targeted and aggressive management of coagulation, kidneys, sepsis, and severe systemic inflammation may improve outcomes of CICs.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Sepse
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Futilidade Médica
Tipo de estudo:
Observational_studies
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Prognostic_studies
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Risk_factors_studies
Limite:
Female
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Humans
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Male
Idioma:
En
Revista:
Hepatol Int
Ano de publicação:
2023
Tipo de documento:
Article
País de afiliação:
Índia