Derivation of a Mortality Prediction Model in Critical Care Patients with Cirrhosis and Sepsis.

OBJECTIVE: To develop a predictive model for in-hospital mortality in critically ill patients with cirrhosis and sepsis, using clinical and laboratory data.

DESIGN: Retrospective cohort study.

SETTING: Medical and mixed ICUs of a tertiary medical center.

PATIENTS: Cirrhotic adults admitted with sepsis to the ICUs from January of 2007 to May of 2017.

INTERVENTIONS: None.

MEASUREMENTS AND MAIN RESULTS: Out of 2595 ICU admissions of patients with cirrhosis, 277 with first ICU admission for sepsis were included in the analysis, and 37% died in the hospital. Patients who stayed in the ICU for at least 6 hours (n = 275) were considered for the multivariate model. Ten-fold cross-validation was used to estimate best parameter values and model performance, and the final model was chosen as the model maximizing area under the receiver-operating characteristic curve. Variables in order of impact were APACHE III score, initial serum lactate, conjugated bilirubin, serum creatinine, MELD score, age, BMI, and serum hemoglobin. The final best model from cross-validation presented an AUC of 0.75, using a cut-point of 50% estimated probability, sensitivity and specificity were 0.46 and 0.90, respectively, with PPV of 0.72 and NPV of 0.74. These results were similar to the APACHE III only model (AUC = 0.74, Sensitivity = 0.43, Specificity = 0.89, PPV = 0.69, NPV = 0.73).

CONCLUSIONS: The combination of initial serum lactate level, conjugated bilirubin, initial serum creatinine, MELD score, age, BMI, and serum hemoglobin did not yield meaningful improvement in the AUC and did not provide advantage over the APACHE III score for the prediction of in-hospital mortality in critically ill patients with cirrhosis and sepsis.