Assessing the prognosis of cirrhotic patients in the intensive care unit: What we know and what we need to know better

Abstract

Critically ill cirrhotic patients have high in-hospital mortality and utilize significant health care resources as a consequence of the need for multiorgan support. Despite this fact, their mortality has decreased in recent decades due to improved care of critically ill patients. Acute-on-chronic liver failure (ACLF), sepsis and elevated hepatic scores are associated with increased mortality in this population, especially among those not eligible for liver transplantation. No score is superior to another in the prognostic assessment of these patients, and both liver-specific and intensive care unit-specific scores have satisfactory predictive accuracy. The sequential assessment of the scores, especially the Sequential Organ Failure Assessment (SOFA) and Chronic Liver Failure Consortium (CLIF)-SOFA scores, may be useful as an auxiliary tool in the decision-making process regarding the benefits of maintaining supportive therapies in this population. A CLIF-ACLF > 70 at admission or at day 3 was associated with a poor prognosis, as well as SOFA score > 19 at baseline or increasing SOFA score > 72. Additional studies addressing the prognostic assessment of these patients are necessary.

Keywords: Cirrhosis; Extrahepatic organ failure; Organ replacement therapy; Mortality; Prognostic scores; Chronic Liver Failure Consortium-Sequential Organ Failure Assessment; Sequential Organ Failure Assessment; Model for End-stage Liver Disease

Core Tip: Assessing the potential benefits of maintaining or suspending supportive therapies for cirrhotic patients who are not eligible for liver transplantation is a major challenge at the bedside, especially in those admitted to general intensive care units (ICUs). In this article, we identify the main causes of ICU admission, analyze the main factors associated with prognosis, and provide a tool to assist the decision-making process.