Beyond Liver Function: Albuminuria and a novel Child-Turcotte-Pugh-AlbU score improve mortality prediction in medical intensive care unit patients with hepatic encephalopathy

TL;DR

Adding albuminuria to a liver disease score improves mortality prediction for patients with hepatic encephalopathy in intensive care.

Contribution

A novel CTP-AlbU score combining albuminuria with the Child-Turcotte-Pugh score improves mortality prediction in hepatic encephalopathy patients.

Findings

The CTP-AlbU score showed a significant association with increased mortality in patients with hepatic encephalopathy.

CTP-AlbU emerged as an independent risk factor for mortality and outperformed the original CTP score in sensitivity.

Albuminuria levels at admission were significantly linked to higher mortality rates in this patient population.

Abstract

This study aimed to evaluate whether incorporating albuminuria (Alb) into the Child-Turcotte-Pugh (CTP) score improves the prediction of mortality in patients with hepatic encephalopathy (HE).

This prospective study was conducted between January 2013 and January 2015 at Al-Azhar University, Cairo, Egypt. Patients who were diagnosed with HE at the time of admission to the medical intensive care unit (MICU) were included. Upon admission, patients underwent HE grading, CTP classification, and an albumin-to-creatinine ratio (ACR) assessment. A novel scoring system, CTP-AlbU, was calculated by combining existing CTP scores with the admission degree of ACR. The primary outcome measure was MICU mortality.

A total of 78 consecutive cirrhotic patients were included in this study with a mean age of 57.65 ± 12.9 years, with equal male and female distribution. HE grades were categorised as 2, 3, and 4 in 16 (20.5%), 44 (56.4%), and 18 (23.1%) patients, respectively. CTP classifications were B and C in 12 (15.4%) and 66 (84.6%) patients, respectively. The overall mortality rate was 32.1%. Statistical analysis revealed a significant association between increased mortality and both elevated ACR and higher CTP-AlbU scores. Furthermore, the CTP-AlbU score emerged as an independent risk factor for mortality.

This study demonstrates that incorporating albuminuria into the CTP score, resulting in the CTP-AlbU score, enhances the prediction of mortality in HE patients. This novel scoring system displayed superior sensitivity compared to the original CTP score, suggesting its potential as a tool for predicting short-term outcomes in this patient population.

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