Prognostic Parameters and Risk Stratification in Intensive Care Patients with Severe Liver Diseases
Keywords:
Liver failure, ICU admission, prognostic parameters, risk stratification, Child-Pugh score, MELD score, Glasgow Coma ScaleAbstract
Background and Aim: Acute or chronic liver failure is associated with numerous complications and patients may require intensive care treatment, which is complex, time-consuming and often highly resource-intensive. Thus, it is necessary to identify clinical parameters that allow quick risk stratification.
Methods: In 117 patients with acute or chronic liver failure requiring ICU admission, the clinical parameters, risk scores and results of microbiological examinations were documented and correlated with the outcome (survivor vs. non-survivor). Results: Predictors of outcome were: Child-Pugh-Score (p < 0.01), MELD-Score (p < 0.01), SAPS-II-Score (p < 0.05), bilirubin (p < 0.01), Glasgow Coma Scale (GCS) (p < 0.02), urine output (p < 0.01), requirement of catecholamine administration (p <0.004), serum creatinine (p < 0.01). The strongest predictors of outcome were in a multivariate model GCS (p = 0.006) and MELD-score (p = 0.001).
Conclusions: Risk stratification in our patient collective was feasible. Apart from parameters to assess kidney function and circulation, various scoring systems that had previously not been evaluated for this kind of patient collective seem to be the main predictors of outcome.
