Prognostic value of international normalized ratio to albumin ratio among critically ill patients with cirrhosis.

ABSTRACT

BACKGROUND AND AIM: Critically ill patients with cirrhosis are at an increased risk of mortality. Our study aimed to externally validate the ability of the prothrombin time-international normalized ratio to albumin ratio (PTAR), an objective and simple scoring system, to predict 90-day mortality in critically ill patients with cirrhosis. PATIENTS AND METHODS: A total of 865 patients were entered into the study, and all the participants were followed up for at least 90 days. Clinical parameters on the first day of intensive care unit admission were included to compare survivors with nonsurvivors. RESULTS: After multivariable adjustment, the association between the risk of 90-day mortality and PTAR remained statistically significant with a hazard ratio of 2.71 (95% confidence interval 1.99-3.68). The PTAR score showed good discrimination ability for predicting 90-day mortality with an area under receiver operating characteristic curve of 0.72 (95% confidence interval 0.68-0.75). To improve its feasibility, we regrouped the PTAR scores into three levels of risk (low risk <0.55, intermediate risk 0.55-1.00, and high risk ≥1.00); the 90-day mortality rates were 20.1% (74/368), 41.7% (168/403), and 73.4% (69/94), respectively. CONCLUSION: The PTAR score system is a convenient and practical tool for predicting the prognosis of critically ill patients with cirrhosis.