Comparison of prognostic systems in cirrhotic patients with hepatic encephalopathy

Abstract

Background/aim: There are various scoring systems for evaluating prognosis in patients hospitalized in intensive care units (ICUs)with hepatic encephalopathy. These include the Child–Turcotte–Pugh (CTP) classification, Model for End-stage Liver Disease (MELD),chronic liver failure–sequential organ failure assessment (CLIF-SOFA), and Acute Physiology and Chronic Health Evaluation II(APACHE II). In this study, we aimed to compare the various scoring systems to determine the best system for showing the prognosisof patients with a prior diagnosis of cirrhosis who were hospitalized for hepatic encephalopathy.Materials and methods: Patients with known cirrhosis hospitalized in the internal medicine ICU of the Adana Numune Educationand Research Hospital with a diagnosis of hepatic encephalopathy were included in the study. Diagnosis and classification of hepaticencephalopathy were done according to the West Haven criteria. The etiology of hepatic encephalopathy was recorded for all patients.APACHE II, CLIF-SOFA, MELD, and CTP scores were calculated for all patients within the first 24 h. Outcomes of patients wererecorded as either discharged or deceased. Demographic and biochemical data, duration of hospitalization, and prognostic factors werecompared for both groups. Area under the receiver operating characteristic curve (AUROC) values were calculated for each scoringsystem.Results: A total of 84 patients were included in the study. The etiologies of encephalopathy were infection (n = 35, 41.7%), varicealbleeding (n = 19, 22.6%), constipation (n = 15, 17.9%), consuming excessive protein (n = 8, 9.5%), hypokalemia (n = 6, 7.1%), andhepatocellular carcinoma (n = 1, 1.2%). Nine patients had grade 1 encephalopathy, 34 patients had grade 2, 27 patients had grade 3, and14 patients had grade 4. AUROC values were 0.986 (0.970–1.003), 0.974 (0.945–1.003), 0.955 (0.915–0.996), and 0.880 (0.800–0.959) forCLIF-SOFA, APACHE II, CTP, and MELD scores, respectively.Conclusion: We found the best prognostic model for patients who were hospitalized in the ICU for hepatic encephalopathy to be CLIFSOFA,followed by APACHE II, CTP, and MELD scores.