And sepsis. These 4 variables are to be analyzed on day 1 of admission to the intensive care unit (ICU). We used this model to analyze and predict the in-hospital mortality in 111 critically ill cirrhotic patients with acute kidney injury (AKI) [11]. The MBRS score [calculated using the following predictors: MAP, ,80 mmHg; serum bilirubin level, .80 mmol/L (4.7 mg/dl); acute respiratory failure, and sepsis] was defined as the sum of 18325633 the values of the individual predictors, each value ranging from 0 to 4. This score has better discriminatory power than the other evaluation systems such as the Child-Pugh [12], model for endstage liver disease (MELD) [13], Acute Physiology and ChronicNew Score in Cirrhosis with AKIHealth Evaluation II and III (APACHE II III) [14,15], and sequential organ failure assessment (SOFA) system [16]. The area under the receiver operating characteristic curve (AUROC) values for the MBRS scores were significantly more than the AUROC values plotted for the Child-Pugh and APACHE II scores [11]. The prognostic value of MBRS scores for cirrhotic patients with AKI admitted to ICUs needs to be validated further through studies on different cohorts. Further confirmation is particularly important because we observed that, over time, the mortality rates of patients who showed the same characteristics at admission typically decreased. Possible causes that may not have affected the scoring variables, including improvements in therapies and management of bleeding, renal failure, respiratory failure, and sepsis, require additional testing in new study cohorts [2,17]. To the best of our knowledge, no prospective clinical study has validated predictive power of MBRS scores on critically ill cirrhotics with AKI. We aimed to evaluate the reproducibility of the MBRS scoring system in predicting the in-hospital mortality rate by performing an external validation.Materials and Methods Ethics statementThis clinical study was conducted in full compliance with the ethical principles of the Declaration of Helsinki and was consistent with Good Clinical Practice guidelines and applicable local regulatory requirements. The local institutional review board of Chang Gung Memorial Hospital approved our study protocol. Patients meeting the inclusion criteria were invited to participate in this study on their first day of ICU admission. Trained physicians evaluated their mental status during the screening and informed consent procedure. Written informed consent was obtained from all mentally competent patients or next-of-kin of compromised ones prior to their participation.Patient information and data collectionThis study was performed between March 2008 and February 2011 in a 10-bed specialized ICU (115103-85-0 hepatogastroenterology ICU) at a 2000-bed tertiary care referral hospital in Taiwan. In this study, we included 190 11089-65-9 consecutive patients with hepatic cirrhosis and AKI requiring intensive monitoring and/or treatment that cannot be provided outside the ICU. We excluded patients who did not match the criteria of AKI (127 patients), patients who had previous end-stage renal disease patients undergoing regular renal replacement therapy (38 patients); patients whose hospital stay length ,24 h (30 patients), patients who had received liver transplantation (16 patients), and patient who were readmitted (21 patients). The following data were collected prospectively: demographic data; reason for admission to the ICU; immediate diagnosis; severity of the illn.And sepsis. These 4 variables are to be analyzed on day 1 of admission to the intensive care unit (ICU). We used this model to analyze and predict the in-hospital mortality in 111 critically ill cirrhotic patients with acute kidney injury (AKI) [11]. The MBRS score [calculated using the following predictors: MAP, ,80 mmHg; serum bilirubin level, .80 mmol/L (4.7 mg/dl); acute respiratory failure, and sepsis] was defined as the sum of 18325633 the values of the individual predictors, each value ranging from 0 to 4. This score has better discriminatory power than the other evaluation systems such as the Child-Pugh [12], model for endstage liver disease (MELD) [13], Acute Physiology and ChronicNew Score in Cirrhosis with AKIHealth Evaluation II and III (APACHE II III) [14,15], and sequential organ failure assessment (SOFA) system [16]. The area under the receiver operating characteristic curve (AUROC) values for the MBRS scores were significantly more than the AUROC values plotted for the Child-Pugh and APACHE II scores [11]. The prognostic value of MBRS scores for cirrhotic patients with AKI admitted to ICUs needs to be validated further through studies on different cohorts. Further confirmation is particularly important because we observed that, over time, the mortality rates of patients who showed the same characteristics at admission typically decreased. Possible causes that may not have affected the scoring variables, including improvements in therapies and management of bleeding, renal failure, respiratory failure, and sepsis, require additional testing in new study cohorts [2,17]. To the best of our knowledge, no prospective clinical study has validated predictive power of MBRS scores on critically ill cirrhotics with AKI. We aimed to evaluate the reproducibility of the MBRS scoring system in predicting the in-hospital mortality rate by performing an external validation.Materials and Methods Ethics statementThis clinical study was conducted in full compliance with the ethical principles of the Declaration of Helsinki and was consistent with Good Clinical Practice guidelines and applicable local regulatory requirements. The local institutional review board of Chang Gung Memorial Hospital approved our study protocol. Patients meeting the inclusion criteria were invited to participate in this study on their first day of ICU admission. Trained physicians evaluated their mental status during the screening and informed consent procedure. Written informed consent was obtained from all mentally competent patients or next-of-kin of compromised ones prior to their participation.Patient information and data collectionThis study was performed between March 2008 and February 2011 in a 10-bed specialized ICU (hepatogastroenterology ICU) at a 2000-bed tertiary care referral hospital in Taiwan. In this study, we included 190 consecutive patients with hepatic cirrhosis and AKI requiring intensive monitoring and/or treatment that cannot be provided outside the ICU. We excluded patients who did not match the criteria of AKI (127 patients), patients who had previous end-stage renal disease patients undergoing regular renal replacement therapy (38 patients); patients whose hospital stay length ,24 h (30 patients), patients who had received liver transplantation (16 patients), and patient who were readmitted (21 patients). The following data were collected prospectively: demographic data; reason for admission to the ICU; immediate diagnosis; severity of the illn.
