Is a specific scoring system developed only for cirrhotic patients with AKI who need intensive care support and not for the general ICU population. Third, we observed that hepatitis B viral infection (43 ) was the leading cause of liverFigure 1. Survival Functions. Cumulative survival in 190 critically ill cirrhotic patients with acute kidney buy BTZ-043 injury according to their MBRS (mean arterial pressure, bilirubin, respiratory failure and sepsis) score after the first day of admission to a specialized hepatogastroenterology intensive care unit. doi:10.1371/journal.pone.0051094.gNew Score in Cirrhosis with AKITable 7. MBRS score for critically ill cirrhotic patients with AKI.MBRS score 0 1 2 3 4 Constantn 12 27 50 72 29 -Hospital mortality ( ) 8 26 72 93 97 -Beta coefficient 0 1.348 3.342 4.993 5.730 -2.Standard error 1.133 1.091 1.143 1.458 1.Odds rations (95 CI) 1 (reference) 3.850 (0.418?5.473) 28.286 (3.334?39.974) 147.740 (15.697?384.178) 308.000 (17.670?368.505) 0.pNS (0.234) 0.002 ,0.001 ,0.001 0.Abbreviation: AKI, acute kidney injury; MBRS, mean arterial pressure, bilirubin, respiratory failure and sepsis; CI, confidence intervals; NS, notsignificant. doi:10.1371/journal.pone.0051094.tcirrhosis in patients and that a high BTZ043 site proportion of patients had hepatoma (31 ). This means that our results cannot be applied to the patients with liver disorders in North American and the European countries because liver diseases in these regions are largely because of hepatitis C viral infection or alcoholism. Fourth, the prognostic instruments were applied on patients already admitted to the specialized hepatogastroenterology ICU and were not used as a preadmission screening test; this may have skewed the results. Fifth, defining baseline SCr as the first value measured during hospitalization might obscure the severity or even the presence of AKI. However, exactly true baseline SCr is not 1531364 always available for all patients in clinical practice. Under various uncontrolled situation, choosing SCr established before admission as baseline value might run the risk to introduce some other biases and reduce the reproducibility of scoring systems. Due to above, many previous large studies also use admission SCr as baseline value to evaluate the impact of AKI on mortality in hospitalized patients [10,25,33]. As a matter of fact, cirrhotic patients who have stable renal function during hospitalization are thought to have a lower mortality rate, and such a relative low risk group is not our study target. Sixth, sequential measurement performed using these scoring systems (for example, daily, weekly) may reflect the dynamic aspects of the clinical diseases, and thus provide better information about the mortality risk in patients. Finally, thepredictive accuracy of logistic regression models has its own limitations.ConclusionIn conclusion, this study showed the grave prognosis in critically ill cirrhotic patient with AKI. The analytical data also showed that the MBRS and APACHE III scoring systems were independent predictors of short-term treatment outcome in critically ill patients. We confirmed that the MBRS scorings system is an accurate, simple, easy-to-apply, reproducible, and economical system capable of providing an improved prediction of prognosis along with objective information for clinical decision making for treating a homogenous group of patients. On the basis of the observed results, we feel that critically ill cirrhotic patients with AKI who show high.Is a specific scoring system developed only for cirrhotic patients with AKI who need intensive care support and not for the general ICU population. Third, we observed that hepatitis B viral infection (43 ) was the leading cause of liverFigure 1. Survival Functions. Cumulative survival in 190 critically ill cirrhotic patients with acute kidney injury according to their MBRS (mean arterial pressure, bilirubin, respiratory failure and sepsis) score after the first day of admission to a specialized hepatogastroenterology intensive care unit. doi:10.1371/journal.pone.0051094.gNew Score in Cirrhosis with AKITable 7. MBRS score for critically ill cirrhotic patients with AKI.MBRS score 0 1 2 3 4 Constantn 12 27 50 72 29 -Hospital mortality ( ) 8 26 72 93 97 -Beta coefficient 0 1.348 3.342 4.993 5.730 -2.Standard error 1.133 1.091 1.143 1.458 1.Odds rations (95 CI) 1 (reference) 3.850 (0.418?5.473) 28.286 (3.334?39.974) 147.740 (15.697?384.178) 308.000 (17.670?368.505) 0.pNS (0.234) 0.002 ,0.001 ,0.001 0.Abbreviation: AKI, acute kidney injury; MBRS, mean arterial pressure, bilirubin, respiratory failure and sepsis; CI, confidence intervals; NS, notsignificant. doi:10.1371/journal.pone.0051094.tcirrhosis in patients and that a high proportion of patients had hepatoma (31 ). This means that our results cannot be applied to the patients with liver disorders in North American and the European countries because liver diseases in these regions are largely because of hepatitis C viral infection or alcoholism. Fourth, the prognostic instruments were applied on patients already admitted to the specialized hepatogastroenterology ICU and were not used as a preadmission screening test; this may have skewed the results. Fifth, defining baseline SCr as the first value measured during hospitalization might obscure the severity or even the presence of AKI. However, exactly true baseline SCr is not 1531364 always available for all patients in clinical practice. Under various uncontrolled situation, choosing SCr established before admission as baseline value might run the risk to introduce some other biases and reduce the reproducibility of scoring systems. Due to above, many previous large studies also use admission SCr as baseline value to evaluate the impact of AKI on mortality in hospitalized patients [10,25,33]. As a matter of fact, cirrhotic patients who have stable renal function during hospitalization are thought to have a lower mortality rate, and such a relative low risk group is not our study target. Sixth, sequential measurement performed using these scoring systems (for example, daily, weekly) may reflect the dynamic aspects of the clinical diseases, and thus provide better information about the mortality risk in patients. Finally, thepredictive accuracy of logistic regression models has its own limitations.ConclusionIn conclusion, this study showed the grave prognosis in critically ill cirrhotic patient with AKI. The analytical data also showed that the MBRS and APACHE III scoring systems were independent predictors of short-term treatment outcome in critically ill patients. We confirmed that the MBRS scorings system is an accurate, simple, easy-to-apply, reproducible, and economical system capable of providing an improved prediction of prognosis along with objective information for clinical decision making for treating a homogenous group of patients. On the basis of the observed results, we feel that critically ill cirrhotic patients with AKI who show high.
