The risk factors of mortality in intensive care unit for cirrhotic patients

It is very important to determine the prognosis of cirrhotic patients in intensive care unit. Prognosis of cirrhotic patients depends on the degree of hepatic failure, complications of cirrhosis and concominant other extrahepatic reasons. Several scoring systems are used to evaluate cirrhotic patient?s prognosis objectively. In this study we aimed to show and compare the usability of scoring systems that are used in cirrhotic patients Child-Turcotte-Pugh (CTP) score and Model for End-stage Liver Disease (MELD) with other scoring systems that used in intensive care unit such as Acute Pysiology and Chronic Healt Evaluation (APACHE ) II and Sequential Organ Failure Assesment (SOFA)201 patients ,130 (% 64,7) male and 71 (% 35,3) female, were included in this study who are admitted to the internal medicine intensive care unit betweeen january 2004 and december 2006. As a risk factor of mortality age, sex, Child-Turcot-Pugh score, Model for End-stage Liver Disease score, Sequential Organ Failure Assesment II score, Sequential Organ Failure Assesment score, serum lactate, blood urea nitrogen, creatinin, total bilirubin, protrombin time, protein electrophoresis, ethyology of cirrhosis, need for mechanical ventilation, duration of hospitalization in intensive care unit, cirrhosis complications such as hepatocellular cancer, gastronintestinal bleeding, hepatorenal syndrome, spontaneus bacterial peritonitis and other infections were evaluated and investigated their influences on prognosis.As a result the patients in the intensive care unit cirrhotic patients were in advanced disease. Because of their cirrhotic complications, these patients generally admitted to the intensive care unit. Mortality rate was quite high (% 41,8). Child-Turcotte-Pugh, Model for End-stage Liver Disease, Acute Pysiology and Chronic Healt Evaluation II, Sequential Organ Failure Assesment and score can be used to predict mortality. Sequential Organ Failure Assesment and Acute Pysiology and Chronic Healt Evaluation II score were powerful to predict mortality than Model for End-stage Liver Disease score and Child-Turcotte-Pugh score (AUROC values respectively 0,847, 0,821, 0,790 and 0,7249). Sequential Organ Failure Assesment score can be performed easily and is the best scoring system. Although Child-Turcotte-Pugh score is most used scoring system in cirrhotic patients, its power to determine prognosis is low. Higher lactate values were assosiated with worse prognosis. Lactate values can be used as a prognostic parameter.Key Words: intensive care unit, prognosis, laktat, Cirrhosis, SOFA score