Acute circulatory failure–chronic liver failure–sequential organ failure assessment score: a novel scoring model for mortality risk prediction in critically ill cirrhotic patients with acute circulatory failure

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Abstract

Background and aim

Acute circulatory failure (ACF) is associated with high mortality rates in critically ill cirrhotic patients. Only a few accurate scoring models exist specific to critically ill cirrhotic patients with acute circulatory failure (CICCF) for mortality risk assessment. The aim was to develop and evaluate a novel model specific to CICCF.

Patients and methods

This study collected and analyzed the data on CICCF from the Multiparameter Intelligent Monitoring in Intensive Care-III database. The acute circulatory failure–chronic liver failure–sequential organ failure assessment (ACF–CLIF–SOFA) score was derived by Cox’s proportional hazards regression. Performance analysis of ACF–CLIF–SOFA against CLIF–SOFA and model for end-stage liver disease systems was completed using area under the receiver operating characteristic curve.

Results

ACF–CLIF–SOFA identified six independent factors: mean arterial pressure [hazard ratio (HR)=0.984, 95% confidence interval (CI): 0.978–0.990, P<0.001], vasopressin (HR=1.548, 95% CI: 1.273–1.883, P<0.001), temperature (HR=0.764, 95% CI: 0.694–0.840, P<0.001), bilirubin (HR=1.031, 95% CI: 1.022–1.041, P<0.001), lactate (HR=1.113, 95% CI: 1.084–1.142, P<0.001), and urine output (HR=0.854, 95% CI: 0.767–0.951, P=0.004). ACF–CLIF–SOFA showed a better predictive performance than CLIF–SOFA and model for end-stage liver disease in terms of predicting mortality (0.769 vs. 0.729 vs. 0.713 at 30 days, 0.757 vs. 0.707 vs. 0.698 at 90 days, 0.733 vs. 0.685 vs. 0.691 at 1 year, respectively, all P<0.05).

Conclusion

ACF–CLIF–SOFA, as the first model specific to CICCF, enables a more accurate prediction at 30-day, 90-day, and 1-year follow-up periods than other existing scoring systems.

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