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. 2023 May;54(5):1374-1378.
doi: 10.1016/j.injury.2023.02.002. Epub 2023 Feb 3.

The COST of liver disease: The Cirrhosis Outcomes Score in Trauma Study

Rachel D Appelbaum  1 , Katherine M Riera  2 , Madeline R Fram  3 , Gregory B Russell  4 , Samuel P Carmichael Ii  5 , R Shayn Martin  6 , J Jason Hoth  7 , Nathan T Mowery  8 , Andrew M Nunn  9
Affiliations

The COST of liver disease: The Cirrhosis Outcomes Score in Trauma Study

Rachel D Appelbaum et al. Injury. 2023 May.

Abstract

Background: Cirrhosis in trauma patients is an indicator of poor prognosis, but current trauma injury grading systems do not take into account liver dysfunction as a risk factor. Our objective was to construct a simple clinical mortality prediction model in cirrhotic trauma patients: Cirrhosis Outcomes Score in Trauma (COST).

Methods: Trauma patients with pre-existing cirrhosis or liver dysfunction who were admitted to our ACS Level I trauma center between 2013 and 2021 were reviewed. Patients with significant acute liver trauma (AAST Grade ≥ 3) or those that developed acute liver dysfunction while admitted were excluded. Demographics as well as ISS, MELD, complications, and mortality were evaluated. COST was defined as the sum of age, ISS, and MELD. Univariate and multivariable analysis was used to determine independent predictors of mortality. The area under the receiver operating curve (AUROC) was calculated to assess the ability of COST to predict mortality.

Results: A total of 318 patients were analyzed of which the majority were males 214 (67.3%) who suffered blunt trauma 305 (95.9%). Mortality at 30-days, 60-days, and 90-days was 20.4%, 23.6%, and 25.5%, respectively. COST was associated with inpatient, 30-day, and 90-day mortality on regression analyses and the AUROC for COST predicting mortality at these respective time points was 0.810, 0.801, and 0.813.

Conclusion: Current trauma injury grading systems do not take into account liver dysfunction as a risk factor. COST is highly predictive of mortality in cirrhotic trauma patients. The simplicity of the score makes it useful in guiding clinical care and in optimizing goals of care discussions. Future studies to validate this prediction model are required prior to clinical use.

Keywords: Cirrhosis in trauma; Cirrhosis mortality prediction; Cirrhosis risk stratification.

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Conflict of interest statement

Declaration of Competing Interest The authors do not have any conflicts of interest to report.

Figures

Figure 1.
Figure 1.
COST AUROC curve for mortality – in-hospital, 30-day, 60-day, 90-day, and 1 year.
Figure 2.
Figure 2.
COST (non-weighted) curve, blue, vs sum of the individually analyzed and weighted COST components (age, ISS, MELD), red, AUROC curve.
Figure 3.
Figure 3.
COST Nomogram. By design, it provides the 100-point scale as a reference for what the system sees as the most important variable.
See this image and copyright information in PMC

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References

    1. Fantus RJ. Tawny trauma: Cirrhosis affects patient response in trauma. FACS Bulletin. 2019. https://bulletin.facs.org/2019/09/tawny-trauma-cirrhosis-affects-patient....
    1. Tinkoff G, Rhodes M, Diamond D, and Lucke J. Cirrhosis in the Trauma Victim. Ann Surg. 1990;211(2):172–177. - PMC - PubMed
    1. Wahlstrom K, Ney AL, Jacobson S, Odland MD, Van Camp JM, and Rodriguez JL et al. Trauma in cirrhotics: survival and hospital sequelae in patients requiring abdominal exploration. Am Surg. 2000;66(11):1071–1076. - PubMed
    1. Christmas AB, Wilson AK, Franklin GA, Miller FB, Richardson JD, and Rodriguez JL. Cirrhosis and Trauma: A Deadly Duo. Am Surg. 2005;71(12):996–1000. - PubMed
    1. Dangleben DA, Jazaeri O, Wasser T, Cipolle M, and Pasquale M. Impact of Cirrhosis on Outcomes in Trauma. J Am Coll Surg. 2006;203:908–913. - PubMed