da Silveira F, Soares PHR, Marchesan LQ, da Fonseca RSA, Nedel WL. Assessing the prognosis of cirrhotic patients in the intensive care unit: What we know and what we need to know better. World J Hepatol 2021; 13(10): 1341-1350 [PMID: 34786170 DOI: 10.4254/wjh.v13.i10.1341]
Corresponding Author of This Article
Wagner L Nedel, MD, MHSc, Chief Doctor, Senior Research Fellow, Intensive Care Unit, Grupo Hospitalar Conceição, Av Francisco Trein, 357, Porto Alegre 91430835, Brazil. wagnernedel@uol.com.br
Research Domain of This Article
Critical Care Medicine
Article-Type of This Article
Minireviews
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Hepatol. Oct 27, 2021; 13(10): 1341-1350 Published online Oct 27, 2021. doi: 10.4254/wjh.v13.i10.1341
Assessing the prognosis of cirrhotic patients in the intensive care unit: What we know and what we need to know better
Fernando da Silveira, Pedro H R Soares, Luana Q Marchesan, Roberto S A da Fonseca, Wagner L Nedel
Fernando da Silveira, Programa de Pós-Graduação em Pneumologia, Universidade Federal do Rio Grande do Sul, Porto Alegre 91430835, Brazil
Fernando da Silveira, Pedro H R Soares, Luana Q Marchesan, Roberto S A da Fonseca, Wagner L Nedel, Intensive Care Unit, Grupo Hospitalar Conceição, Porto Alegre 91430835, Brazil
Pedro H R Soares, Programa de Pós-Graduação em Neurociências, Universidade Federal do Rio Grande do Sul, Porto Alegre 91430835, Brazil
Luana Q Marchesan, Programa de Pós-Graduação em Ciências da Saúde, Universidade Federal de Santa Maria, Santa Maria 97105900, Brazil
Wagner L Nedel, Programa de Pós-Graduação em Bioquímica, Universidade Federal do Rio Grande do Sul, Porto Alegre 91430835, Brazil
Author contributions: da Silveira F, Soares PHR, Marchezan LQ, da Fonseca RSA, Nedel WL collected the data and wrote the manuscript; da Silveira F and Nedel WL reviewed the manuscript.
Conflict-of-interest statement: There is no conflict of interest in writing this manuscript.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Wagner L Nedel, MD, MHSc, Chief Doctor, Senior Research Fellow, Intensive Care Unit, Grupo Hospitalar Conceição, Av Francisco Trein, 357, Porto Alegre 91430835, Brazil. wagnernedel@uol.com.br
Received: February 25, 2021 Peer-review started: February 25, 2021 First decision: May 3, 2021 Revised: May 11, 2021 Accepted: September 27, 2021 Article in press: September 27, 2021 Published online: October 27, 2021 Processing time: 238 Days and 19.6 Hours
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.
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.
