Bao et al developed models for evaluating a patient with cirrhosis in the intensive care unit (ICU). This can help to identify a patient who may require more aggressive management. The authors are from Zhejiang University, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease (Hangzhour, China) and Heidelberg University.
Patient selection: patient with cirrhosis in the ICU
Outcome: 3-month (90-day) mortality
Parameters on day of admission:
(1) total serum bilirubin in µmol/L
(2) prothrombin time (PT) in seconds
(3) SIRS
(4) hepatic encephalopathy (HE)
(5) vasopressor therapy
|
Parameter
|
Finding
|
Points for LR Model
|
Points for Score
|
|
total serum bilirubin
|
<= 75 µmol
|
0.004 * (bilirubin)
|
0
|
|
|
> 75µmol
|
0.004 * (bilirubin)
|
1
|
|
PT in seconds
|
<= 19 seconds
|
0.014 * (PT)
|
0
|
|
|
> 19 seconds
|
0.014 * (PT)
|
1
|
|
SIRS
|
absent
|
0
|
0
|
|
|
present
|
1.677
|
3
|
|
hepatic encephalopathy
|
absent
|
0
|
0
|
|
|
present
|
0.318
|
2
|
|
vasopressor therapy
|
no
|
0
|
0
|
|
|
yes
|
0.950
|
3
|
X =
= SUM(points from LR model) -2.337
probability of mortality =
= 1 / (1 + EXP((-1) * X))
total point score =
= SUM(points for all 5 parameters)
Interpretation:
• minimum point score: 0
• maximum point score: 10
• A score of 10 is associated with 100% mortality.
• The prognosis deteriorated with the total number of risk factors present (from 0 to 5).
Performance:
• The area under the ROC curve is reported as 0.846.
• The Youden index is 0.67 at cutoff of 4 with sensitivity of 92% and specificity of 75%.
