Admission of Cirrhotic Patients in Intensive Care Unit: Is the Child-Pugh Score a Useful Tool?

Abstract

The improvement of cirrhotic patient’s prognosis in intensive care unit for 10 years is explained by standardization of the management of complications of cirrhosis and the overall improvement in the management of patients in intensive care. However, the mortality of these patients remains high and the means of selection to admit these patients are still debated. Many recent studies have compared the specific scores of cirrhosis and the ICU specific scores. Specific ICU scores, in this indication, have the best prognostic performance with areas under the ROC curve exceeding 0.9 sometimes. The Child-Pugh score is the least efficient of these scores even if it is useful. In practice, the thresholds of 10.5 and 47.5 SOFA SAPS II on admission distinguish populations at high risk of in-hospital mortality. The benefit of transfer in ICU in this population isn’t certain, especially in elderly patients or in absence of liver transplantation project. After three days, persistence of 3 non-haematological organ failures and/or modified SOFA score ≥12, associated with a mortality of about 90%, have to discuss limitation of treatment. Admission of cirrhotic patients with gastrointestinal bleeding seems relevant because, in this particular case, survival at 6 weeks is elevated over than 80%. New specifics scores of “liver failure in ICU” have been developed in recent months but have not been validated yet in independent cohorts.