Comparison of Different Scoring Systems in Predicting Short-Term Mortality After Liver Transplantation

doi:10.1016/j.transproceed.2014.11.067

Transplantation Proceedings

Volume 47, Issue 4, May 2015, Pages 1207-1210

https://doi.org/10.1016/j.transproceed.2014.11.067 Get rights and content

Highlights

•
Liver transplantation is the only curative treatment for ESLD and selected primary hepatic malignancies.
•
SOFA score is superior for MELD, APACHE II, and CTP scores in predicting short-term outcomes.
•
Respiratory rate, serum bilirubin level, and duration of ICU stay may be risk factors related to early mortality after LDLT.

Abstract

Background

Many scoring systems have been used in predicting the outcomes of liver transplantations. The aim of this study was to compare between 4 scoring systems—Sequential Organ Failure Assessment (SOFA), Model for End-Stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, and Child Turcotte-Pugh —among patients who underwent living-donor liver transplantation (LDLT) seeking to evaluate the best system to correlate with post-operative outcomes.

Methods

This study retrospectively reviewed the medical records of 53 patients who had received LDLT in a tertiary care hospital from January 2005 to December 2010. Demographic, clinical, and laboratory data were recorded. Each patient was assessed by use of 4 scoring systems before transplantation and on post-operative days 1 to 7 and at 3 months.

Results

The overall 3-month survival rate was 64%. The pre-transplant SOFA score had the best discriminatory power; moreover, the SOFA score on post-operative day 7 had the best Youden index (.875). The survival rate at 3-month follow-up after liver transplantation differed significantly (P = .00023, highest area under the receiver operator characteristic curve = .952) between patients who had SOFA scores <8 and those had SOFA score >8 on post–liver transplant day 7. This study also demonstrated that respiratory rate (P = .017) and serum bilirubin level (P = .048) and duration of intensive care unit stay (P = .04) are significant risk factors related to early mortality after LDLT.

Conclusions

The pre-transplant SOFA score was a statistically significant predictor of 3-month mortality; SOFA score on post–liver transplant day 7 had the best discriminative power for predicting 3-month mortality.

Section snippets

Methods

The protocol of this study was approved by the scientific board of faculty of medicine, Cairo University Egypt, which ceded obtaining informed consent. A review was conducted of retrospectively collected medical records of 53 patients who had received LDLT in a tertiary care hospital (Kasr Alainy Hospital) from January 2005 to December 2010. Data collected included demographic data, clinical and laboratory results, length of ICU stay, and outcome. Liver disease was largely attributed to

Results

The characteristics of 53 liver transplant recipients are listed in Table 1. The overall 3-month survival rate was 64% (34/53), based on 3-month mortality after liver transplantation patients were divided into 2 groups: survivors (group I) and non-survivors (group II).

We compared demographic, clinical, and laboratory data between the 2 groups as shown in Table 2. The mean values for respiratory rate, total bilirubin level, and duration of ICU stay after surgery were significantly higher in

Discussion

Many scoring systems had been applied for prediction of outcomes in patients admitted to ICUs; however, the application of scoring systems in allograft recipients has not been studied enough [17]. In liver allograft recipients, many factors may affect their outcomes during the period of ICU admission [18], [19]. In the present study, we compared 4 severity classification systems concerning mortality retrospectively after liver transplantation.

According to our results, the 3-month mortality rate

Conclusions

This study illustrates the excellent prognostic power of SOFA score and its superiority for other scoring systems in predicting short-term mortality after LDLT.

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Early predictors of prolonged intensive care utilization following liver transplantation
2023, American Journal of Surgery
Creatinine, bilirubin, and fibrinolysis resistance are associated with multi-organ dysfunction and likely risk factors for prolonged intensive care unit (pICU) stay following liver transplantation (LT). We hypothesize postoperative day-1 (POD-1) labs will predict pICU.
LT recipients had clinical laboratories and viscoelastic testing with tissue plasminogen activator thrombelastography (tPA TEG) to quantify fibrinolysis resistance (LY30) on POD-1. pICU was defined as one week or longer in the ICU. Logistic regression was used to identify the relationship between POD-1 labs and pICU.
Of 304 patients, 50% went to the ICU, with 15% experiencing pICU. Elevated creatinine (OR 6.6, P < 0.001) and low tPA TEG LY30 (OR 3.7, P = 0.004) were independent predictors of pICU after controlling for other risk factors. A 9-fold increase in the rate of 90-day graft loss (19% vs 2% p < 0.001) was observed patients who had these risk factors for pICU.
Elevated creatine and fibrinolysis resistance are associated with pICU and poor outcomes following LT.
Impact of the Acute and Chronic Liver Failure–Sequential Evaluation of Organ Failure Scoring System on the Prognosis of Liver Transplant
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Citation Excerpt :
The results are presented in Table 2. In several recent studies, the CLIF-SOFA scoring system has been shown to be a statistically significant predictor of survival at 1 year after liver transplant [3,4]. In fact, in 1 study, the discriminative power of mortality at 1 year of the CLIF-SOFA was superior to the MELD [4].
The use of the Model of End-Stage Liver Disease (MELD) to predict morbidity and mortality after orthotopic liver transplant (OLT) is controversial. Acute and chronic liver failure–sequential evaluation of organ failure (CLIF-SOFA) is a new score that assess the patient's global status and that have been developed exclusively for patients with end-stage liver disease. The objective is to evaluate whether the CLIF-SOFA system predicts postoperative morbidity and mortality in the short and medium term.
A cohort of 123 patients who underwent OLT in a tertiary care hospital between January 2016 and December 2017 was retrospectively analyzed. The patients were divided into 2 groups: group 1 with a CLIF-SOFA score <7 and group 2 with a score CLIF-SOFA ≥7.
Patients with a CLIF-SOFA ≥7 present, with statistical significance, had higher mortality at 1 and 3 years; longer duration of admission to the critical care unit; longer hospital stay; need for prolonged mechanical ventilation; surgical reintervention; higher rate of transfusion of blood products; pulmonary, neurologic, hemodynamic, surgical, infectious, kidney, metabolic, thrombotic, vascular, and graft complications; and need for kidney replacement therapy. However, no statistically significant differences were found in mortality in the first month, the need for hospital readmission, retransplant, digestive, endocrine, nutritional, hematologic, or biliary complications, and the presence of ascites.
The role of CLIF-SOFA as a prognostic factor for mortality after OLT must be taken into account. Our results should be taken with caution, and more studies are necessary.
Mapping nursing interventions using the Therapeutic Intervention Scoring System in bloodless liver transplantations
2020, Intensive and Critical Care Nursing
Citation Excerpt :
The Sequential Organ Failure Assessment (SOFA) score is a widely used organ dysfunction score to characterise patient severity and predictoutcome. The Child Pugh and Model for End-Stage Liver Disease (MELD) scores are commonly used to assess the severity of liver dysfunction and to predict the outcome of cirrhotic patients (Elsayed, Sholkamy, Elshazli, Elshafie, & Naguib, 2015) (Piotrowski, Sączewska-Piotrowska, Jaroszewicz, & Boroń-Kaczmarska, 2018). These scoring systems stratify the severity of illness during critical care but do not perform well as measures or indicators of nursing workload (Greaves et al., 2018).
The Simplified Therapeutic Intervention Scoring System adapted to liver transplantation by King's College Hospital rank 138 activities to determine the nursing workload, diagnostic, monitoring and therapeutic needs.
To evaluate nursing activities of “King’s-TISS” score grouped in organ systems and nurse patient ratio in the perioperative 48 hours of blood product free liver transplantations (LT).
The “King’s-TISS” score’s were analysed by nursing procedures and grouped, scored according to organ systems. The nursing workloads were studied during LT (T1), on arrival on the ICU (T2) and 12–24-48 hours after LT (T3-T4-T5).
The total of “King’s-TISS” score points were decreased by ≥20% daily (p = 0.001). The mean score of 104 ± 3.5 points (CI:104–105) during LT decreased to 84.7 ± 12 points (CI:83–86) in 48 hours (T5). The “metabolic” and “haemostasis” points increased (p = ).01), the “immunology” points unchanged (T2-T5) postoperatively. A slight decrease was observed in case of “basic nursing care”, “monitoring”, “neurologic support”, “renal support” and “cardiovascular support” points (T2-T5, p < .01). The “invasive intervention” and “ventilatory support” points strongly decreased (T2-T5, p < .001). One “King’s-TISS” point was found to equal 7.4 minutes with a nurse patient ratio of 2:1 intraoperatively and 1:1 postoperatively.
Absence of blood product administration in LT decreases the total and organ specific workload, except the metabolic, haemostasis, immunology and basic support requirement. It was not within the scope of the King’s-TISS score to analyse the application of viscoelastic haemostasis test and coagulation factor concentrate administration.
Mortality Predictors After Liver Transplant in the Intensive Care Unit
2018, Transplantation Proceedings
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The findings of this study suggest that APACHE II was a predictive mortality score after liver TX (P = .0046) in the multivariate analysis. Thus, Elsayed et al [12], in comparing 2 groups of survivors and nonsurvivors of liver TX, found that APACHE II presented a high level of significance on the first and seventh days of ICU admission to predict mortality after TX. Zhang et al [11] also observed that APACHE II was a predictor of patient mortality after liver TX.
The goal of this study was to evaluate the predictive factors of mortality in patients after liver transplantation in an intensive care unit from the University Hospital.
This observational study was conducted by using a database analysis of University Hospital. The sample consisted of patients after liver transplantation registered in the database. The study variables of Sequential Organ Failure Assessment score, Acute Physiology and Chronic Health Disease Classification II (APACHE II), Model for End-Stage Liver Disease, and Child-Pugh scores, and the days of hospitalization in intensive care unit, mechanical ventilation time, and reintubation rate, were correlated. Statistical analysis was performed by using the χ² test or Fisher exact test, the Mann-Whitney test, and logistic regression analysis.
Fifty-eight individuals were analyzed. In the death group, the days of hospitalization in the intensive care unit were within 12 ± 14 days, the time of mechanical ventilation was 180 ± 148 hours, the APACHE II value was 17.6 ± 7.3, the Sequential Organ Failure Assessment score was 8.2 ± 2.7, and reintubation was 40%. In the multivariate regression, the predictive indexes of mortality were the mortality given by APACHE II (odds ratio, 1.1; CI, 1.03–1.17; P = .004), mechanical ventilation time (odds ratio, 1.02; CI, 1.01–1.04; P = .001), and reintubation (odds ratio, 9.06; CI, 1.83–44.9; P = .007). An increase of 1 unit in APACHE II mortality increases the risk of death by 10.2%, and each hour of mechanical ventilation increases the risk of death by 2.6%.
The time of mechanical ventilation, orotracheal reintubation, and the mortality given by APACHE II were the variables that best predicted death in this study.
Risk Factors for Mortality in 272 Patients With Lung Transplant: A Multicenter Analysis of 7 Intensive Care Units
2017, Archivos de Bronconeumologia
Citation Excerpt :
The SOFA (Sequential Organ Failure Assessment) score is a composite score comprising 6 items: the respiratory, coagulation, hepatic, cardiovascular, renal and neurological systems. It is used to track patient status during ICU stay and to establish the extent of organ function or failure.3 Pulmonary graft dysfunction (PGD) severity was graded according to the International Society for Heart and Lung Transplantation (ISHLT) consensus,4 using the partial pressure of arterial oxygen (PaO2) to fraction of inspired oxygen (FiO2) ratio.
One-year survival in lung transplant is around 85%, but this figure has not increased in recent years, in spite of technical improvements.
Retrospective, multicenter cohort study. Data from 272 eligible adults with lung transplant were recorded at 7 intensive care units (ICU) in Spain in 2013. The objective was to identify variables that might help to guide future clinical interventions in order to reducethe risk of death in the postoperative period.
One patient (0.3%) died in the operating room and 27 (10%) within 90 days. Twenty (7.4%) died within 28 days, after a median of 14 ICU days. Grade 3 pulmonary graft dysfunction was documented in 108 patients, of whom 21 died, compared with 6 out of 163 without pulmonary graft dysfunction (P < .001). At ICU admission, non-survivors had significantly lower (P = .03) median PaO2/FiO2 (200 mmHg vs 280 mmHg), and the difference increased after 24 hours (178 vs 297 mmHg, P < .001). Thirteen required extracorporeal membrane oxygenation, and 7(53.8%) died. A logistic regression model identified pulmonary graft dysfunction (OR: 6.77), donor age > 60yr (OR: 2.91) and SOFA > 8 (OR: 2.53) as independent predictors of 90-day mortality. At ICU admission, higher median procalcitonin (1.6 vs 0.6) and lower median PaO2/FiO2 (200 vs 280 mmHg) were significantly associated with mortality.
Graft dysfunction remains a significant problem in lung transplant. Early ICU interventions in patients with severe hypoxemia or high procalcitonin are crucial in order to lower mortality.
La supervivencia anual del trasplante de pulmón está alrededor del 85% y este porcentaje no se ha incrementado recientemente, a pesar de mejoras técnicas.
Estudio de cohortes, multicéntrico, retrospectivo. Se recogieron datos de 272 adultos con trasplante de pulmón en 7 unidades de cuidados intensivos españolas en 2013. El objetivo fue identificar variables que pudieran ser de utilidad para guiar futuras intervenciones clínicas para disminuir el riesgo de fallecer en el postoperatorio.
Un paciente (0,3%) falleció en quirófano y 27 (10%) a los 90 días. Veinte (7,4%) fallecieron en 28 días, después de una mediana de 14 días en unidad de cuidados intensivos. La disfunción primaria grado 3 se documentó en 108 pacientes, de los cuales 21 fallecieron, comparado con 6 de 163 sin disfunción primaria grado 3 (p < 0,001). Al ingreso en unidad de cuidados intensivos, los no supervivientes mostraban una significativa menor mediana (p = 0,03) de PaO2/FiO2 (200 vs. 280 mmHg); esta diferencia se incrementó a las 24 h (178 vs. 297 mmHg, p < 0,001). Trece requirieron oxigenación con membrana extracorpórea (53,8%) y 7 fallecieron. Un modelo de regresión logística múltiple identificó la disfunción primaria grado 3 (OR: 6,77), edad donante > 60 años (OR: 2,91) y SOFA > 8 (OR: 2,53) como predictores independientes (p < 0,05) de mortalidad a los 90 días. En el ingreso en unidad de cuidados intensivos, una mediana de procalcitonina plasmática superior (1,6 vs. 0.6 ng/mL) e inferior de PaO2/FiO2 (200 vs. 280 mmHg) se asociaron independientemente (p < 0,05) con la mortalidad.
La disfunción primaria del injerto continúa siendo un problema significativo en el trasplante pulmonar. Las intervenciones precoces dirigidas a mejorar la hipoxemia o la identificación de elevación de procalcitonina representan oportunidades para disminuir la mortalidad.
Arterial blood pressure waveform in liver transplant surgery possesses variability of morphology reflecting recipients’ acuity and predicting short term outcomes
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14th Congress of the Middle East Society for Organ Transplantation and the 5th Middle East Transplant GamesLiver transplantationComparison of Different Scoring Systems in Predicting Short-Term Mortality After Liver Transplantation

Highlights

Abstract

Background

Methods

Results

Conclusions

Section snippets

Methods

Results

Discussion

Conclusions

Gastroenterology

Liver Transpl

Hepatology

Peripheral arterial vasodilation hypothesis: a proposal for the initiation of sodium and water retention in cirrhosis

Hepatology

Management of cirrhosis and ascites

N Engl J Med

The hyperdynamic circulation of chronic liver diseases: from the patient to the molecule

Hepatology

Nitric oxide as a mediator of hemodynamic abnormalities and sodium and water retention in cirrhosis

N Engl J Med

Neuronal nitric oxide synthase and systemic vasodilation in rats with cirrhosis

Am J Physiol Renal Physiol

Prognosis of patients with cirrhosis and chronic liver disease admitted to the medical intensive care unit

Crit Care Med

Multivariate regression analysis on early mortality after orthotopic liver transplantation

World J Gastroenterol

14th Congress of the Middle East Society for Organ Transplantation and the 5th Middle East Transplant Games
Liver transplantation
Comparison of Different Scoring Systems in Predicting Short-Term Mortality After Liver Transplantation