Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Apr;17(2):476-487.
doi: 10.1007/s12072-022-10426-4. Epub 2022 Oct 13.

PIRO-CIC model can predict mortality and futility of care in critically ill cirrhosis patients in the intensive care unit

Rakhi Maiwall  1 , Samba Siva Rao Pasupuleti  2 , Harsh Vardhan Tevethia  1 , Shiv Kumar Sarin  3
Affiliations

PIRO-CIC model can predict mortality and futility of care in critically ill cirrhosis patients in the intensive care unit

Rakhi Maiwall et al. Hepatol Int. 2023 Apr.

Abstract

Background: Dynamic assessment of critically ill patients with cirrhosis (CICs) is required for accurate prognostication.

Objective: Development of a dynamic model for prediction of mortality and decision on futility of care in CICs.

Design and setting: In a prospective cohort study, we developed the PIRO-CIC model (predisposition, injury, response, organ failure for critically ill cirrhotics)] in a derivative cohort (n = 360) and validated it (n = 240) for patients admitted to the Liver ICU.

Patients: Decompensated cirrhosis admitted to ICU. The model was developed using Cox-regression analysis, and futility was performed by decision-curve analysis.

Results: CICs aged 48 ± 11.5 years, 87% males, majority being alcoholics, were enrolled, of which 73.5% were alive at one month. Factors significant for P component were INR [hazard ratio 1.12, 95% confidence interval 1.07-1.18] and CystatinC [2.25, 1.70-2.97]; for I component were sepsis [4.69, 1.90-11.57], arterial lactate[1.40, 1.02-1.93] and alcohol as etiology [2.78, 1.85-4.18]; for R component-systemic inflammatory response syndrome [1.97, 1.14-3.42] and urine neutrophil-gelatinase-associated lipocalin [HR 2.37, 1.59-3.53]; for O component-low PaO2/FiO2 ratio and need of mechanical ventilation [7.41, 4.63-11.86]. The PIRO-CIC model predicted one-month mortality with a C-index of 0.83 in the derivation and 0.80 in the validation cohorts. It predicted futility of care better than other prognostic scores. The immediate risk of mortality increased by 39% with each unit increase in PIRO-CIC score.

Limitations: Not applicable for acute-on-chronic liver failure and patients requiring emergency liver transplant.

Conclusions: Assessment and stratification of CICs with the dynamic PIRO-CIC model could determine one-month mortality and futility in the first week. Targeted and aggressive management of coagulation, kidneys, sepsis, and severe systemic inflammation may improve outcomes of CICs.

Keywords: ACLF; AKI; Cystatin C; Lactate; NGAL; Sepsis.

PubMed Disclaimer

Similar articles

See all similar articles

Cited by

References

    1. Olson JC, Wendon JA, Kramer DJ, et al. Intensive care of the patient with cirrhosis. Hepatology. 2011;54:1864–1872 - DOI - PubMed
    1. Cholongitas E, Senzolo M, Patch D, et al. Risk factors, sequential organ failure assessment and model for end-stage liver disease scores for predicting short term mortality in cirrhotic patients admitted to intensive care unit. Aliment Pharmacol Ther. 2006;23:883–893 - DOI - PubMed
    1. Das V, Boelle PY, Galbois A, et al. Cirrhotic patients in the medical intensive care unit: early prognosis and long-term survival. Crit Care Med. 2010;38:2108–2116 - DOI - PubMed
    1. Gustot T, Fernandez J, Garcia E, et al. Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis. Hepatology. 2015;62:243–252 - DOI - PubMed
    1. Fu CM, Chang CH, Fan PC, et al. Prognosis of critically ill cirrhotic versus non-cirrhotic patients: a comprehensive score-matched study. BMC Anesthesiol. 2014;14:123 - DOI - PubMed - PMC

LinkOut - more resources