Abstract:
PURPOSE:To develop a liver function-related risk prediction tool to identify acute-on-chronic liver failure patients at greatest risk of in-hospital mortality. METHODS:The LiFe (liver, injury, failure, evaluation) score, was constructed based on the opinions of 157 intensivists within the European Society for Intensive Care Medicine. Experts were surveyed and instructed to weigh the diagnostic importance of each feature of a proposed prediction model. We performed a retrospective cohort study of 1916 patients with chronic liver disease admitted to a medical or surgical ICU between 1997, and 2011 in three large hospitals in Boston, USA, and London, UK, with arterial lactate, total bilirubin and INR drawn at ICU admission. The derivation cohort consisted of ICU patients from Brigham and Women's Hospital and Massachusetts General Hospital in Boston (n = 945), and the validation cohort comprised patients from Kings College Hospital, London, admitted to the Liver Intensive Therapy Unit (n = 971). A clinical prediction model was derived and validated based on a logistic regression model describing the risk of in-hospital mortality as a function of the predictors (arterial lactate 0-1.9, ≥2.0-3.9, ≥4.0-5.9, ≥6.0 mg/dL; total bilirubin 0-1.9, ≥2.0-3.9, ≥4.0-5.9, ≥6.0 mg/dL; INR 0-1.9, ≥2.0-3.9, ≥4.0-5.9, ≥6.0) at ICU admission. Performance analysis of the LiFe score against SOFA, CLIF-SOFA, APACHE II and SAPS II was completed in the validation cohort of critically ill cirrhotic patients. RESULTS:The derivation cohort (n = 941) was 53% male with a mean age of 65 years and an in-hospital mortality rate of 30%. The validation cohort (n = 971) was 63% male with mean age of 51 years and an in-hospital mortality rate of 52%. The C statistic for the prediction model was 0.74 (95% CI 0.70-0.77) in the derivation cohort and 0.77 (95% CI 0.74-0.80) in the validation cohort. In the validation cohort, in-hospital mortality was 17% in the low-risk group (0 risk score points), 28% in the intermediate-risk group (1-3 points), 47% in the high-risk group (4-8 points), and 77% in the very high-risk group (>8 points). In the validation cohort, the C statistics for SOFA, CLIF-SOFA, APACHE II, and SAPS II were 0.80, 0.81, 0.77, and 0.78, respectively. Further, a significant positive correlation exists between LiFe score and acute-on-chronic liver failure grade, (r = 0.478, P < 0.001). CONCLUSIONS:Our LiFe score calculated from arterial lactate, total bilirubin and INR at ICU admission is a simple, quick and easily understandable score that may increase clinical utility for risk prediction in ICU patients with acute-on-chronic liver failure. The LiFe score can be used in place of physiological based scores for early risk prediction in patients with chronic liver disease but is not intended to replace CLIF-SOFA as a benchmark for prognostication.
journal_name
Intensive Care Medjournal_title
Intensive care medicineauthors
Edmark C,McPhail MJW,Bell M,Whitehouse T,Wendon J,Christopher KBdoi
10.1007/s00134-015-4203-5subject
Has Abstractpub_date
2016-03-01 00:00:00pages
361-369issue
3eissn
0342-4642issn
1432-1238pii
10.1007/s00134-015-4203-5journal_volume
42pub_type
杂志文章,多中心研究abstract:: ...
journal_title:Intensive care medicine
pub_type: 评论,社论
doi:10.1007/s00134-018-5399-y
更新日期:2018-11-01 00:00:00
abstract::Activation of the complement system within the lung can lead to acute pulmonary damage and dysfunction. Based on a variety of experimental models it is now apparent that lung injury is related to complement-induced generation of oxygen derived free radicals from neutrophils and from macrophages. In addition to the oxy...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00315362
更新日期:1986-01-01 00:00:00
abstract:INTRODUCTION:A prospective physiological study was performed in 12 paediatric patients with acute moderate hypercapnic respiratory insufficiency to assess the ability of noninvasive positive pressure ventilation (NPPV) to unload the respiratory muscles and improve gas exchange. MATERIALS AND METHODS:Breathing pattern,...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s00134-008-1202-9
更新日期:2008-12-01 00:00:00
abstract:OBJECTIVE:In normal subjects cerebral CO2 vasoreactivity is measured during spontaneous hyperventilation, breathholding, or adding CO2 to inspiratory gases. The correlation between CO2 and cerebral blood flow may, however, be invalidated by the effects of a modified respiratory pattern on venous return, sympathovagal b...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s001340051239
更新日期:2000-06-01 00:00:00
abstract:OBJECTIVE:To examine variables associated with postextubation respiratory distress in chronic obstructive pulmonary disease (COPD) patients. DESIGN:Prospective, clinical investigation. SETTING:Intensive care unit of a university hospital. PATIENTS:Forty COPD patients, considered ready for extubation. MEASUREMENTS A...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/s001340050762
更新日期:1998-12-01 00:00:00
abstract:OBJECTIVE:(1) To describe the pattern of intracranial pressure (ICP) and cerebral perfusion pressure (CPP) in a group of severe head-injured patients, (2) to quantify complications of ICP monitoring, and (3) to describe a management protocol and its results. DESIGN:Prospective observational study. SETTING:General int...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340050860
更新日期:1999-04-01 00:00:00
abstract:OBJECTIVE:To compare outcome prediction using the Multiple Organ Dysfunction Score (MODS) and the Sequential Organ Failure Assessment (SOFA), two of the systems most commonly used to evaluate organ dysfunction in the intensive care unit (ICU). DESIGN:Prospective, observational study. SETTING:Thirty-one-bed, universit...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1491-3
更新日期:2002-11-01 00:00:00
abstract:PURPOSE:Protective mechanical ventilation based on multiple ventilator parameters such as tidal volume, plateau pressure, and driving pressure has been widely used in acute respiratory distress syndrome (ARDS). More recently, mechanical power (MP) was found to be associated with mortality. The study aimed to investigat...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-019-05627-9
更新日期:2019-06-01 00:00:00
abstract:PURPOSE:Mechanical ventilation with lower tidal volumes (≤6 ml/kg of predicted body weight, PBW) could benefit patients without acute respiratory distress syndrome (ARDS). However, tidal volume reduction could be associated with increased patient discomfort and sedation needs, and consequent longer duration of ventilat...
journal_title:Intensive care medicine
pub_type: 杂志文章,meta分析,评审
doi:10.1007/s00134-014-3318-4
更新日期:2014-07-01 00:00:00
abstract:OBJECTIVE:Percutaneous dilatational tracheostomy is increasingly practiced in intensive care units and has a low incidence of early complications. The late effects of this procedure are still poorly known and were the focus of this study. DESIGN:Prospective descriptive clinical study. SETTING:Interdisciplinary intens...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF01706200
更新日期:1995-06-01 00:00:00
abstract:PURPOSE:Assessment of the cost utility (CU) of acute renal replacement therapy (RRT) from a societal perspective during a 5-year follow-up. METHODS:This was a cross-sectional cohort study in a medical-surgical intensive care unit and an acute RRT unit of 410 consecutive patients treated with acute RRT in Helsinki Univ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2760-4
更新日期:2013-03-01 00:00:00
abstract:OBJECTIVE:Measurement of functional residual capacity (FRC) during controlled and especially during assisted ventilation remains a challenge in the physiological evaluation of ventilated patients. To validate a bag-in-box closed helium dilution technique allowing measurements both during pressure-controlled (PCV) and p...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-007-0833-6
更新日期:2007-12-01 00:00:00
abstract:PURPOSE:To determine whether erythromycin is non-inferior to metoclopramide in facilitating post-pyloric placement of self-propelled spiral nasoenteric tubes (NETs) in critically ill patients. METHODS:A prospective, multicenter, open-label, parallel, and non-inferiority randomized controlled trial was conducted compar...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1007/s00134-018-5466-4
更新日期:2018-12-01 00:00:00
abstract::The effects of 142 intravenous boluses of althesin (0.05 ml/kg) on cerebral perfusion pressure (CPP) were studied in twelve head injured comatose patients. The data were divided into those where the mean pre-bolus intracranial pressure (ICP) was above or below 20 mmHg and then subdivided into those where the minimum p...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00257469
更新日期:1988-01-01 00:00:00
abstract:PURPOSE:To describe the course of early organ dysfunction in a cohort of patients admitted in ICU suffering classic heatstroke. METHODS:Prospective observational single-centre cohort study with a 1-year follow-up. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:Clinical and biological data of 22 patients were anal...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-009-1500-x
更新日期:2009-08-01 00:00:00
abstract::Placement of a Swan-Ganz catheter can cause many complications. This case report presents a new complication of Swan-Ganz catheter insertion--placement of the Swan-Ganz catheter tip in the coronary sinus. ...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00254707
更新日期:1987-01-01 00:00:00
abstract::This article was originally published under a CC BY-NC 4.0 license, but has now been made available under a CC BY 4.0 license. The PDF and HTML versions of the paper have been modified accordingly. ...
journal_title:Intensive care medicine
pub_type: 杂志文章,已发布勘误
doi:10.1007/s00134-018-5254-1
更新日期:2018-05-01 00:00:00
abstract:PURPOSE:Critically ill patients often require CT scans. Adverse events (AE) can occur during intra-hospital transport (IHT). The aim of this prospective study was to determine the diagnostic and therapeutic yield and the safety of CT scans in ICU patients. METHODS:All ICU patients having a CT scan for diagnostic purpo...
journal_title:Intensive care medicine
pub_type: 杂志文章,多中心研究
doi:10.1007/s00134-014-3592-1
更新日期:2015-03-01 00:00:00
abstract::Peritonitis has been produced in rabbits by the spreading of 5 ml of caecal contents throughout the peritoneal cavity. After sacrifice at 5 h, electron microscopy revealed a increase of 600% in PMN and 1200% in lymphocytes in the pulmonary capillaries of the test animals when compared to the sham operated group. The p...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00265119
更新日期:1987-01-01 00:00:00
abstract:OBJECTIVE:Capillary leakage syndrome (CLS) is a frequent complication in sepsis, characterized by loss of intravasal fluids leading to generalized edema and hemodynamic instability despite massive fluid therapy. In spite of its importance no standardized diagnostic criteria are available for CLS. DESIGN:Prospective cl...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340000601
更新日期:2000-09-01 00:00:00
abstract::Measurements of added inspiratory work (AIW) of breathing imposed by three different CPAP systems were performed in 10 patients. One system was a continuous flow system while the two others were demand flow systems separated from respirators (Ohmeda VD 101 and Draeger CPAP 800 devices). AIW was calculated from pressur...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00292929
更新日期:1986-01-01 00:00:00
abstract:OBJECTIVE:To measure the effects of rapid permissive hypercapnia on hemodynamics and gas exchange in patients with acute respiratory distress syndrome (ARDS). DESIGN:Prospective study. SETTING:18-bed, medical intensive care unit, university hospital. PATIENTS:11 mechanically ventilated ARDS patients. INTERVENTION:P...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章
doi:10.1007/BF01712235
更新日期:1996-03-01 00:00:00
abstract:PURPOSE:Although low doses of oxygen (FiO2 <0.50) are considered nontoxic, recent studies have shown that even lower doses increase pulmonary inflammatory mediators. We aimed to evaluate the acute effects of reducing FiO2 on pulmonary inflammation in mechanically ventilated patients without respiratory failure. METHOD...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-012-2801-z
更新日期:2013-04-01 00:00:00
abstract:OBJECTIVE:To assess the outcome of intensive care unit (ICU) treatment in patients with hematological malignancies. DESIGN AND SETTING:Retrospective cohort study in the medical ICU of a university hospital. PATIENTS:104 critically ill patients after receiving conventional chemotherapy or autologous hematopoietic stem...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s00134-002-1420-5
更新日期:2002-09-01 00:00:00
abstract:BACKGROUND:Vasopressors are administered to critically ill patients with vasodilatory shock not responsive to volume resuscitation, and less often in cardiogenic shock, and hypovolemic shock. OBJECTIVES:The objectives are to review safety and efficacy of vasopressors, pathophysiology, agents that decrease vasopressor ...
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s00134-019-05801-z
更新日期:2019-11-01 00:00:00
abstract::Membranous laryngotracheobronchitis is a very serious infection which affects the larynx, trachea and bronchi, requiring aggressive therapeutic measures. It has been recently rediscovered as a cause of disease in children. However, it is a very unusual complication of measles. Two infants with measles and membranous l...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/BF00273547
更新日期:1985-01-01 00:00:00
abstract::Physicians are increasingly involved in how their critically ill patients die [72]. The more this happens, the more physicians will have to understand not only how their own backgrounds and biases influence their medical management, but also the cultural and religious backgrounds of the patient and surrogate [72, 73]....
journal_title:Intensive care medicine
pub_type: 杂志文章,评审
doi:10.1007/s001340000641
更新日期:2000-10-01 00:00:00
abstract:OBJECTIVE:To determine if the plasma levels of three endothelial-specific proteins, von Willebrand factor (vWF), tissue factor pathway inhibitor (TFPI) and thrombomodulin (TM) may be useful in predicting the development of acute respiratory distress syndrome (ARDS). DESIGN:Blood samples were obtained from normal healt...
journal_title:Intensive care medicine
pub_type: 杂志文章
doi:10.1007/s001340051054
更新日期:1999-11-01 00:00:00
abstract::The article "Accumulation of hydroxyethyl starch in human and animal tissues: a systematic review", written by Christian J. Wiedermann and Michael Joannidis, was originally published Online First without Open Access. ...
journal_title:Intensive care medicine
pub_type: 已发布勘误
doi:10.1007/s00134-020-06269-y
更新日期:2020-10-14 00:00:00
abstract::There has been little research on smoking cessation after critical illness. Smokers make up a high percentage of patients admitted to intensive care (ICU) and stopping smoking is one message that should be clearly given to recovering patients. The recovery period provides an important opportunity for patients to quit ...
journal_title:Intensive care medicine
pub_type: 临床试验,杂志文章,随机对照试验
doi:10.1007/s001340101051
更新日期:2001-09-01 00:00:00