Dynamic Prognostication in Critically Ill Cirrhotic Patients With Multiorgan Failure in ICUs in Europe and North America: A Multicenter Analysis

Objectives: To evaluate the Chronic Liver Failure-Consortium Acute on Chronic Liver Failure score in acute on chronic liver failure patients admitted to ICUs from different global regions and compare discrimination ability with previously published scores. Design: Retrospective pooled analysis. Setting: Academic ICUs in Canada (Edmonton, Vancouver) and Europe (Paris, Barcelona, Chronic liver failure/Acute-on-Chronic Liver Failure in Cirrhosis [CANONIC] study). Patients: Sample of analysis of 867 cirrhotic patients with acute on chronic liver failure admitted to ICU. Cumulative incidence functions of death were estimated by acute on chronic liver failure grade at admission and at day 3. Survival discrimination abilities of Chronic Liver Failure-Consortium Acute on Chronic Liver Failure, Model for End-Stage Liver Disease, Acute Physiology and Chronic Health Evaluation II, and Child-Turcotte-Pugh scores were compared. Interventions: ICU admission for organ support. Measurements and Main Results: At admission 169 subjects (19%) had acute on chronic liver failure 1, 302 (35%) acute on chronic liver failure 2, and 396 (46%) had acute on chronic liver failure 3 with 90-mortality rates of 33%, 40%, and 74%, respectively (p 70), decisions regarding transition to palliation should be explored between patient families and the ICU providers after a short trial of therapy. This article followed the Strengthening the Reporting of Observational Studies in Epidemiology guideline (Supplementary File 9, Supplemental Digital Content 9, https://ift.tt/2MmDQIF). This work was performed at the University of Alberta, European Foundation for the Study of Chronic Liver Failure, Barcelona Clinic, University of British Columbia and Hospital Paul-Brousse (Paris, France). Dr. Karvellas conceived the idea for the study, performed data analysis, and drafted the article. Ms. Garcia-Lopez performed statistical analyses and significantly revised final article. Drs. Fernandez, Saliba, Sy, Jalan, Pavesi, Gustot, Ronco provided data and significantly revised final article. Dr. Arroyo assisted with study design and analysis and significantly revised final article. All authors approve the final manuscript. Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's website (https://ift.tt/29S62lw). Supported, in part, by the European Association for the Study of Liver Chronic Liver Failure Consortium has an unrestricted grant from Grifols. Dr. Karvellas disclosed that the European Association for the Study of Liver Chronic Liver Failure Consortium has an unrestricted grant from Grifols (however, he is not part of this consortium). Ms. Garcia-Lopez disclosed work for hire. Dr. Fernandez received funding from Grifols SA. Dr. Jalan's institution received funding from Yaqrit Limited (he founded this company to develop three interventions that were developed in his laboratory and University, and he has collaborative grants), Ocera Therapeutics (a drug he invented for the treatment of hepatic encephalopathy is licensed by his university to this company), Sequana Medical (chief investigator on a study funded by this company), and Takeda (research collaboration). The remaining authors have disclosed that they do not have any potential conflicts of interest. Address requests for reprints to: Constantine J. Karvellas, MD, FRCPC, Division of Gastroenterology (Liver Unit), Department of Critical Care Medicine, University of Alberta, 1–40 Zeidler Ledcor Building, Edmonton, AB T6G-2X8, Canada. E-mail: dean.karvellas@ualberta.ca Copyright © by 2018 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.

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