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Nomogram model for hospitalized patients in the ICU for alcohol-related cirrhosis: A step closer to the continuing search for an ideal prognostic model

  • Anand V. Kulkarni
    Affiliations
    Department of Hepatology and Liver Transplantation, AIG Hospitals, Hyderabad, India
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  • Ashwani K. Singal
    Correspondence
    Corresponding author at: Professor of Medicine University of SD Sanford SOM, Transplant Hepatologist and Chief Clinical Research, Avera University Hospital and Transplant Institute, Research Scientist VA Medical Centre, Sioux Falls SD, United States.
    Affiliations
    Department of Medicine, University of South Dakota, Sioux Falls, SD, United States

    Avera Transplant Institute and Division of Hepatology, Sioux Falls, SD, United States

    VA Medical Center, Sioux Falls, SD, United States
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Published:February 13, 2023DOI:https://doi.org/10.1016/j.dld.2023.01.164
      Cirrhosis is a frequent cause for hospitalization, with up to 15% in the United Kingdom and 25,000 patients in the United States requiring Intensive Care Unit (ICU) care [
      • Warren A.
      • Soulsby C.R.
      • Puxty A.
      • et al.
      Long-term outcome of patients with liver cirrhosis admitted to a general intensive care unit.
      ,
      • Olson J.C.
      • Wendon J.A.
      • Kramer D.J.
      • et al.
      Intensive care of the patient with cirrhosis.
      ]. Patients with cirrhosis requiring ICU care are at risk for high inpatient mortality and represent an economic burden, with a total of $9.8 billion in expenses for direct patient care in 2011 [
      • Huang Y.-.F.
      • Lin C.-.S.
      • Cherng Y.-.G.
      • et al.
      A population-based cohort study of mortality of intensive care unit patients with liver cirrhosis.
      ,
      • Allen A.M.
      • Kim W.R.
      • Moriarty J.P.
      • et al.
      Time trends in the health care burden and mortality of acute on chronic liver failure in the United States.
      ]. Alcohol-associated cirrhosis (ALC) worldwide accounts for over 330,000 deaths, which represented 27.3% of all cirrhosis-related deaths in 2017 [
      • Singal A.K.
      • Mathurin P.
      Diagnosis and Treatment of Alcohol-Associated Liver Disease: a Review.
      ]. Several scores, such as Child-Pugh, MELD, MELD-Na, ABC-lactate, and CLIF-SOFA, have been developed to estimate disease severity and prognosis for hospitalized patients with cirrhosis, however these are limited by sample size, lack of validation, and inaccuracy [
      • Smith T.N.
      • Gallo De Moraes A.
      • Simonetto D.A.
      Cirrhosis management in the Intensive Care Unit.
      ].
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