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Erschienen in:
13.10.2022 | Original Article
PIRO-CIC model can predict mortality and futility of care in critically ill cirrhosis patients in the intensive care unit
Erschienen in: Hepatology International | Ausgabe 2/2023
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Background
Dynamic assessment of critically ill patients with cirrhosis (CICs) is required for accurate prognostication.
Objective
Development of a dynamic model for prediction of mortality and decision on futility of care in CICs.
Design and setting
In a prospective cohort study, we developed the PIRO-CIC model (predisposition, injury, response, organ failure for critically ill cirrhotics)] in a derivative cohort (n = 360) and validated it (n = 240) for patients admitted to the Liver ICU.
Patients
Decompensated cirrhosis admitted to ICU. The model was developed using Cox-regression analysis, and futility was performed by decision-curve analysis.
Results
CICs aged 48 ± 11.5 years, 87% males, majority being alcoholics, were enrolled, of which 73.5% were alive at one month. Factors significant for P component were INR [hazard ratio 1.12, 95% confidence interval 1.07–1.18] and CystatinC [2.25, 1.70–2.97]; for I component were sepsis [4.69, 1.90–11.57], arterial lactate[1.40, 1.02–1.93] and alcohol as etiology [2.78, 1.85–4.18]; for R component-systemic inflammatory response syndrome [1.97, 1.14–3.42] and urine neutrophil-gelatinase-associated lipocalin [HR 2.37, 1.59–3.53]; for O component-low PaO2/FiO2 ratio and need of mechanical ventilation [7.41, 4.63–11.86]. The PIRO-CIC model predicted one-month mortality with a C-index of 0.83 in the derivation and 0.80 in the validation cohorts. It predicted futility of care better than other prognostic scores. The immediate risk of mortality increased by 39% with each unit increase in PIRO-CIC score.
Limitations
Not applicable for acute-on-chronic liver failure and patients requiring emergency liver transplant.
Conclusions
Assessment and stratification of CICs with the dynamic PIRO-CIC model could determine one-month mortality and futility in the first week. Targeted and aggressive management of coagulation, kidneys, sepsis, and severe systemic inflammation may improve outcomes of CICs.
Graphical abstract
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