Objective: End-stage liver disease is frequently complicated by renal function disturbances. Cirrhotic patients with renal failure admitted to intensive care units (ICUs) have high mortality rates. This study analyzed the outcomes of critically ill cirrhotic patients and identified the association between prognosis and RIFLE (risk of renal failure, injury to kidney, failure of kidney function, loss of kidney function, and end-stage renal failure) classification, in comparison with other five scoring systems.
Design: Prospective, clinical study.
Setting: Ten-bed specialized hepatogastroenterology ICU in a university hospital in Taiwan.
Patients and participants: One hundred and thirty-four cirrhotic patients consecutively admitted to ICU during a 1.5-year period.
Interventions: Thirty-two demographic, clinical and laboratory variables were analyzed as predictors of survival.
Measurements and main results: Overall hospital mortality was 65.7%. There was a progressive and significant increase (chi2 for trend: p<0.001) in mortality based on RIFLE classification severity. Multiple logistic regression analysis indicated that RIFLE classification and Sequential Organ Failure Assessment (SOFA) score on the first day of ICU admission were independent risk factors for hospital mortality. By using the areas under the receiver operating characteristic curve (AUROC), the RIFLE category and SOFA both indicated a good discriminative power (AUROC 0.837+/-0.036 and 0.917+/-0.025; p<0.001). Cumulative survival rates at 6-month follow-up differed significantly (p<0.05) for non-ARF vs. RIFLE-R, RIFLE-I, and RIFLE-F.
Conclusion: Both SOFA and RIFLE category showed high discriminative power in predicting hospital mortality in critically ill patients with cirrhosis. The RIFLE classification is a simple and easily applied evaluative tool with good prognostic abilities.