Validation of Circom comorbidity score in critically-ill cirrhotic patients

Abstract

Background and aim of work: CirCom score has been designed specifically for cirrhotic patients as it is used to reassess which comorbidities associate with mortality of those patients. The current study was designed to assess the performance of CirCom comorbidity score in predicting the mortality of critically ill cirrhotic patients of hepatitis C virus (HCV) etiology. Methodology: 1085 consecutive patients admitted to the ICU in a two-year period were included. All were anti-HCV Ab positive with liver cirrhosis and portal hypertension as evidenced by clinical examination, laboratory, ultrasonographic and endoscopic features. None of them received oral antiviral treatment. Results: Out of the 1085 Patients, 321 (29.5%) patients died and 764 (70.4%) survived. Co-morbidities were found in 572 (52.7%), CirCom score 0 in 47.28%, 1 + 0 in 4.33%, 1 + 1 in 7.19%, 3 + 0 in 6.45%, 3 + 1 in 9.4%, 5 + 0 in 12.16%, 5 + 1 in 13.18%. Adjusted ORs for increased risk of death were 2.07, 2.65, 4.62, 6.72, 8.43 and 12.87, respectively. Overall, the model correctly predicted 82.24% of patients. Conclusion: The CirCom score performance as a measure of the burden of comorbidity in critically ill cirrhotic patients is fairly good and 82.24% of patients were correctly predicted by the model. Actual and expected survivals were comparable. This emphasizes the importance of including a measure of comorbidity in comparative studies of cirrhosis survival.

Keywords

• CirCom comorbidity score
• Critically ill cirrhotic
• ICU mortality
• Risk score