Serum Lactate & Cystatin C Based Model of End Stage Liver Disease (MELD) As Prognostic Factors in Patients with Liver Cirrhosis in Intensive Care Unit
Journal Title: International Journal of Medical Research Professionals - Year 2018, Vol 4, Issue 4
Abstract
Background: Cirrhotic patients admitted to the intensive care unit (ICU) usually have multi-organ failure. Multiple organ failure entails a very poor outcome in all intensive care patients .The use of prognostic models for patients admitted to ICU is of great importance, since they provide an objective evaluation for a group of patients with potentially high mortality rates and cost. The advanced stage of liver failure and presence of cirrhotic complications contribute to poor prognosis of cirrhotic patients admitted to ICU. Objective: To determine whether serum lactate level and MELD based cystatin C score give any predictive value for cirrhotic patient prognosis and mortality in ICU and also to determine whether MELD based cystatin C is better than the usual MELD score in the prognostic performance. Methods: In all the patients enrolled, a diagnosis of cirrhosis was confirmed by resorting to clinical, laboratory, and ultrasonographic findings. During this period, patients with cirrhosis were admitted to the ICU with varying indications. Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), cystatin c based Model for End-stage Liver Disease (MELD-cys), Acute Physiology and Chronic Health Evaluation (APACHE II) and Sequential Organ Failure Assessment (SOFA) scores and lactate were compared between deceased and discharged patients. Results: A total of 89 consenting patients were enrolled in this study. The mean age of all the patients was 59.9± 10.25. The etiological factors for cirrhosis were mainly HCV and HBV. Lactate level, CTP, APACHE II, MELD, MELD -cys and SOFA scores were significantly higher inpatients who died than in those who were discharged from the ICU (p values were <0.001, 0.31, < 0.001, < 0.001,<0.001 and < 0.001 respectively). Conclusion: Serum lactate and MELD-cys score are good prognostic factors and have a high mortality prediction in liver cirrhosis patients who were admitted to ICU. Substitution of creatinine by cystatin C does not improve the predictive power of MELD score. In terms of prognostic value, SOFA score, APACHE II score and lactate level are superior to the MELD cys, MELD and CTP scores (in the same order) in predicting mortality in liver cirrhosis patients in ICU.
Authors and Affiliations
Ayman M Alzamzamy, Ashraf A Barakat, Hany V Zaki, Walid H Nofal, Walid A Altaher, Ayman M Kamaly
Keywords
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- EP ID EP535170
- DOI 10.21276/ijmrp.2018.4.4.043
- Views 91
- Downloads 0
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