Indian Journal of Critical Care Medicine

Register      Login



Volume / Issue

Online First

Related articles

VOLUME 23 , ISSUE 10 ( October, 2019 ) > List of Articles

Original Article

Scoring Systems that Predict Mortality at Admission in End-stage Liver Disease

Neeraj Mangla, Ravi Bokarvadia, Joy Varghese, Jayanthi Venkataraman

Keywords : Cirrhosis, Emergency, Mortality

Citation Information : Mangla N, Bokarvadia R, Varghese J, Venkataraman J. Scoring Systems that Predict Mortality at Admission in End-stage Liver Disease. Indian J Crit Care Med 2019; 23 (10):445-448.

DOI: 10.5005/jp-journals-10071-23261

License: CC BY-NC 4.0

Published Online: 01-08-2019

Copyright Statement:  Copyright © 2019; The Author(s).


Background: Various scoring systems have been developed to assess the severity and survival in end-stage liver disease. Aim of the study: Prospective study to compare and analyze the efficacy of scoring systems in predicting mortality in ESLD patients who present with cirrhosis specific complications to the emergency room. Materials and methods: This prospective, single point study was conducted over a two year period from September 2014 to August 2016 among 162 ESLD patients seeking admission to the emergency unit of Gleneagles Global Health City, Chennai. Baseline investigations incorporated hemogram, liver biochemical parameters, coagulation parameters (PT/INR), serum creatinine, serum electrolytes and blood gas analysis, to calculate the CTP score, MELD, MELD-Na, MESO, iMELD, Updated MELD, UKELD, SOFA and APACHE II. Comparison of MELD snd non MELD scores were done between survivors and nonsurvivors. The mortality rate for the same admission was calculated. Results: Of the 162 patients requiring emergency admision, 148 were men (91.4%). The median age of patients was 56 years (range 25–75 years). The cause for liver cirrhosis was alcohol followed by nonalcoholic steatohepatitis and hepatitis B. The indications for emergency admissions were fever, tense ascites, reduced urine output and altered sensorium. Thirty patients (18.5%) expired during the same admission. The predictive accuracy of all scores for predicting mortality by ROC curves was between 0.7 and 0.8 (p < 0.05). Conclusion: Although, all scores appear to be equally good, simple scores like CTP and MELD is all that is required to ascertain the prognosis of patients seeking emergency admission.

PDF Share
  1. Cholongitas E, Papatheodoridis GV, Vangeli M, Terreni N, Patch D, Burroughs A K. Systematic review: the model for end-stage liver disease - should it replace Child-Pugh's classification for assessing prognosis in cirrhosis? Aliment Pharmacol Ther 2005;22:1079–1089
  2. Kammath PS, Wiesner RH, Malinhoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with endstage liver disease. Hepatology 2001;33:464–470.
  3. Biggins SW, Kim WR, Terrault NA, Saab S, Balan V, Schiano T, et al. Evidence-based incorporation of serum sodium concentration into MELD. Gastroenterology 2006;130:1652–1660.
  4. Luca A, Angermayr B, Bertolini G, Koenig F, Vizzini G, Ploner M, et al. An integrated MELD model including serum sodium and age improves the prediction of early mortality in patients with cirrhosis. Liver Transpl 2007;13:1174–1180.
  5. Huo TI, Wang YW, Yang YY, Lin HC, Lee PC, Hou MC, et al. Model for end-stage liver disease score to serum sodium ratio index as a prognostic predictor and its correlation with portal pressure in patients with liver cirrhosis. Liver Int 2007;27:498–506.
  6. Neuberger J, Gimson A, Davies M, Akyol M, O'Grady J, Burroughs A, et al. Selection of patients for liver transplantation and allocation of donated livers in the UK. Gut 2008;57:252–257.
  7. Sharma P, Schaubel DE, Sima CS, Merion RM, Lok AS. Re-weighting the model for end-stage liver disease score components. Gastroenterology. 2008;135:1575–1581.
  8. Heuman DM, Mihas AA, Habib A, Gilles HS, Stravitz RT, Sanyal AJ, et al. MELD-XI: a rational approach to “sickest first” liver transplantation in cirrhotic patients requiring anticoagulant therapy. Liver Transpl 2006;13:30–37.
  9. Knaus WA, Draper EA, Wagner DP, Zimmerman JE. “APACHE II: a severity of disease classification system”. Critical Care Medicine 1985;13:818–829.
  10. Vincent JL, Moreno R, Takala J, Willatts S, De Mendonça A, Bruining H, et al. The SOFA (Sepsis-related Organ Failure Assessment) score to describe organ dysfunction/failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine. Intensive Care Med 1996;22:707–710.
  11. Pant C, Olyaee M, Gilroy R, Pandya PK, Olson JC, Oropeza-Vail M, et al. Emergency Department Visits Related to Cirrhosis: A Retrospective Study of the Nationwide Emergency Department Sample 2006 to 2011. Chiu. K-W, ed. Medicine 2015;94:e308.
  12. Boone MD, Celi LA, Ho BG, Pencina M, Curry MP, Lior Y, et al. Model for end-stage liver disease score predicts mortality in critically ill cirrhotic patients. J Crit Care 2014;29:881.
  13. Tu KH, Jenq CC, Tsai MH, Hsu HH, Chang MY, Tian YC, et al. Outcome scoring systems for short-term prognosis in critically ill cirrhotic patients. Shock 2011;36:445–450.
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.