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Pang-Chi Chen

Publications and source records attributed to Pang-Chi Chen.

At least 19 recordsLinked to original sources
PubMed2006

The outcome assessment of double-balloon enteroscopy for diagnosing and managing patients with obscure gastrointestinal bleeding.

Diagnosing and treating patients with obscure gastrointestinal bleeding is clinically challenging. Most lesions responsible for the origin of obscure gastrointestinal bleeding are located in the small bowel. Double-balloon enteroscopy is a novel method for exploring the small intestine and has significant therapeutic potential. This study evaluated the value of double-balloon enteroscopy in diagnosing and managing obscure gastrointestinal bleeding. From October 2003 to January 2006, a total of 20 patients (6 men, 14 women; mean age, 55.2 years old) with obscure gastrointestinal bleeding (18 obscure overt bleeding, 2 obscure occult bleeding) were investigated by double-balloon enteroscopy. A total of 29 procedures (15 via oral approach and 14 via rectal approach) were performed. The diagnostic yield, endoscopic therapeutic procedures, complications, and outcome were then assessed. Small bowel lesions potentially responsible for the bleeding were identified in 15 (75%) of 20 patients, including 9 angiodysplasias, 2 gastrointestinal stromal tumors (GISTs), 2 ulcers, 1 jejunal granulation polyp, and 1 Peutz-Jeghers polyposis. Endoscopic treatments including heater probe coagulation, polypectomy, and endoscopic mucosal resection were performed in 11 patients. Two patients with GISTs received surgical intervention. Two patients with angiodysplasias that endoscopic treatment failed underwent laparoscopic resections following tattooing. There were no complications and the procedures were tolerated well. Among the 15 patients who had a lesion identified with subsequent treatment, rebleeding occurred in 3 (20%) patients with angiodysplasias. Of the five patients in whom no definite lesion was detected, rebleeding developed in four (80%). For patients with an identified lesion that was further treated, the rebleeding rate was lower than for those with "persistent" obscure gastrointestinal bleeding (P=0.031). We conclude that double-balloon enteroscopy offers a safe and effective method for diagnosing and managing patients with obscure gastrointestinal bleeding.

Angiodysplasia↗
PubMed2006

Adrenal insufficiency in patients with cirrhosis, severe sepsis and septic shock.

Patients with cirrhosis are susceptible to bacterial infection, which can result in circulatory dysfunction, renal failure, hepatic encephalopathy, and a decreased survival rate. Severe sepsis is frequently associated with adrenal insufficiency, which may lead to hemodynamic instability and a poor prognosis. We evaluated adrenal function using short corticotropin stimulation test (SST) in 101 critically ill patients with cirrhosis and severe sepsis. Adrenal insufficiency occurred in 51.48% of patients. The patients with adrenal insufficiency had a higher hospital mortality rate when compared with those with normal adrenal function (80.76% vs. 36.7%, P < .001). The cumulative rates of survival at 90 days were 15.3% and 63.2% for the adrenal insufficiency and normal adrenal function groups, respectively (P < .0001). The hospital survivors had a higher cortisol response to corticotropin (16.2 +/- 8.0 vs. 8.5 +/- 5.9 microg/dL, P < .001). The cortisol response to corticotropin was inversely correlated with various disease severity, Model for End-Stage Liver Disease, and Child-Pugh scores. Acute physiology, age, chronic health evaluation III score, and cortisol increment were independent factors to predict hospital mortality. Mean arterial pressure on the day of SST was lower in patients with adrenal insufficiency (60 +/- 14 vs. 74.5 +/- 13 mm Hg, P < .001), and a higher proportion of these patients required vasopressors (73% vs. 24.48%, P < .001). Mean arterial pressure, serum bilirubin, vasopressor dependency, and bacteremia were independent factors that predicted adrenal insufficiency. In conclusion, adrenal insufficiency is common in critically ill patients with cirrhosis and severe sepsis. It is related to functional liver reserve and disease severity and is associated with hemodynamic instability, renal dysfunction, and increased mortality.

Adrenal Glands↗
PubMed2006

Nasogastric feeding tube placement in patients with esophageal cancer: application of ultrathin transnasal endoscopy.

BACKGROUND: Patients with esophageal cancer often present with dysphagia and malnutrition. Obstructive symptoms may improve after radiotherapy and chemotherapy. Nutrition support via a nasogastric tube (NG) or gastrostomy is very important during treatment. The newly developed ultrathin endoscope (Olympus, GIF-N230, outer diameter: 6 mm) has a smaller diameter than the standard endoscope and can be introduced into the esophagus via the nasal cavity. This article reports on the use of an ultrathin endoscope for NG placement for patients with esophageal cancer who presented with dysphagia and failed traditional NG tube placement. METHODS: A consecutive series of 40 patients with esophageal cancer were referred to our hospital from November 2001 to October 2002 for endoscopic placement of NG tubes due to failure of traditional methods of NG placement. An ultrathin endoscope was used to advance the guidewire into the stomach via the nasal cavity. After withdrawal of the scope, the NG tube was inserted over the guidewire under fluoroscopy. OBSERVATIONS: A total of 71 procedures were performed in 40 patients (37 males, 3 females), age 57 +/- 15 years (range, 37-91 y). Seventy procedures (99%) were successful in completing NG tube placement by using an ultrathin transnasal endoscope. Only one procedure failed because the esophageal lumen was completely occluded and the guidewire was not able to be passed through the obstructed site. The average duration that the NG tube was left in place was 49 +/- 35 days (range, 2-144 days). No procedure-related complications, such as bleeding or perforation, occurred. CONCLUSIONS: Using ultrathin transnasal endoscopy to place an NG tube for esophageal cancer patients is effective and safe. It simplifies the procedures and increases the success rate.

Adult↗
PubMed2006

Comparative study of conventional colonoscopy, chromoendoscopy, and narrow-band imaging systems in differential diagnosis of neoplastic and nonneoplastic colonic polyps.

AIM: To identify the feasibility of the narrow-band imaging (NBI) method compared with that of conventional colonoscopy and chromoendoscopy for distinguishing neoplastic and nonneoplastic colonic polyps. METHOD: This study enrolled consecutive patients who underwent colonoscopy using a conventional colonoscope between January and February 2006 at Chang-Gung Memorial Hospital, Linkou Medical Center, Taiwan. These 78 patients had 110 colorectal polyps. During the procedure, conventional colonoscopy first detected lesions, and then the NBI system was used to examine the capillary networks. Thereafter indigo carmine (0.2%) was sprayed directly on the mucosa surface prior to evaluating the crypts using a conventional colonoscope. The pit patterns were characterized using the classification system proposed by Kudo. Finally, a polypectomy or biopsy was performed for histological diagnosis. RESULTS: Of the 110 colorectal polyps, 65 were adenomas, 40 were hyperplastic polyps, and five were adenocarcinomas. The NBI system and pit patterns for all lesions were analyzed. For differential diagnosis of neoplastic (adenoma and adenocarcinoma) and nonneoplastic (hyperplastic) polyps, the sensitivity of the conventional colonoscope for detecting neoplastic polyps was 82.9%, specificity was 80.0% and diagnostic accuracy was 81.8%, significantly lower than those achieved with the NBI system (sensitivity 95.7%, specificity 87.5%, accuracy 92.7%) and chromoendoscopy (sensitivity 95.7%, specificity 87.5%, accuracy 92.7%). Therefore, no significant difference existed between the NBI system and chromoendoscopy during differential diagnosis of neoplastic and nonneoplastic polyps. CONCLUSION: The NBI system identified morphological details that correlate well with polyp histology by chromoendoscopy.

Adult↗
PubMed2005

How can colorectal neoplasms be treated during colonoscopy?

AIM: For many physicians who ordinarily treat patients with colonic diseases, colonoscopy is considered a prime study interest. Developments in colonoscopic equipment and methods have led to a large number of endoscopic diagnoses and treatment for colorectal neoplasms. The purpose of this investigation is to evaluate the efficacy and outcomes of endoscopic treatment for colorectal neoplastic lesions. METHODS: From September 1999 to May 2003, 11 447 consecutive colonoscopic examinations in 9864 patients were gathered; totaling 5502 endoscopic treatments for colorectal neoplasms. Macroscopic characteristics of the neoplasms were classified into protruded (n = 3 953), sessile (n = 1402), lateral spreading tumor (n = 139) and depressed lesions (n = 8). Snare polypectomy was conducted in 3984 lesions, hot forcep removal in 1368 lesions, and endoscopic mucosal resection in 150 lesions. RESULTS: Histological diagnoses were 4596 neoplastic lesions (4 376 adenomas and 220 adenocarcinomas) and 906 non-neoplastic lesions (891 hyperplastic and 15 inflammatory polyps). For the adenocarcinoma group, 31 instances involved submucosal invasion or resection margin, who received further operations, while 13 surgical specimens discovered no residual tumors. Three perforations and 96 bleedings were found following endoscopic treatment. No procedure-related mortality was found and no recurrent malignancy was found after 14-56 mo follow-up. CONCLUSION: To lower the incidence and mortality of colorectal cancer, endoscopic treatment for colorectal neoplasms is a simple and safe procedure.

Adenocarcinoma↗
PubMed2005

Isolated varices over hepatic flexure colon indicating superior mesenteric venous thrombosis caused by uncinate pancreatic head cancer--a case report.

Very rare cases of varices involving right side colon were reported. Most of them were due to cirrhotic portal hypertension or other primary causes. No report case contributed to pancreatic cancer. Here, we reported a case of uncinate pancreatic cancer with the initial finding of isolated hepatic flexure colon varices. Following studies confirmed isolated varices involving hepatic flexure colon due to pancreatic cancer with occlusion of superior mesenteric vein. From this report, superior mesenteric vein occlusion caused by uncinate pancreatic head cancer should be considered as a differential diagnosis of colon varices.

Colon↗
PubMed2005

Double balloon enteroscopy-the last blind-point of the gastrointestinal tract.

Technical challenges have obstructed the diagnosis and treatment of small intestine disease. An innovative form of enteroscopy-the double balloon method-permits visualization of the complete small intestine, to-and-fro examination of an area of interest, and biopsy and endoscopic procedures which are safer, faster, and less painful than earlier methods. From October 2003 to May 2004, a total of 10 patients with obscure gastrointestinal bleeding received 12 enteroscopic examinations, 8 per oral and 4 per rectal examinations, while 2 patients received per oral enteroscopy first and further per rectal procedures 2 days later. Two cases with intestinal submucosal tumors were discovered by per oral enteroscopy, one with a 5-cm SMT with reddish mucosa at the jejunum and another with a 4-cm SMT and surface ulceration, in which the biopsy showed GIST. Both patients received an operation later. Four patients were found to have intestinal angiodysplasia in jejunum(per oral) and one in ileum (per rectal), and after local therapy bleeding stopped. Multiple angiodysplasias were observed in a patient who was operated on for active bleeding from the ileum after Indian ink tattooing. The two patients who received per oral and per rectal procedures did not display definite small intestinal lesions. All patients underwent the procedures satisfactorily without any complications, and the examination times varied from 90 to 360 min. Double balloon enteroscopy permits deep insertion of an endoscope into the small intestine without excessive stretching of the intestinal tract. This method can use either an oral or an anal approach. To-and-fro observation of almost the complete small intestine is possible, as are interventions.

Adult↗
PubMed2005

Endoscopic mucosal resection for colonic non-polypoid neoplasms.

BACKGROUND: Colonic neoplastic lesions can be classified morphologically into polypoid and non-polypoid types. Non-polypoid lesions have a higher malignant potential than polypoid lesions. Removing these lesions and obtaining integral specimen for histopathology evaluation during colonoscopy examination is an important task. Endoscopic mucosal resection (EMR) is an alternative to surgery for removing of non-polypoid lesions of the GI tract. This study assessed the safety, efficacy, and clinical outcomes of EMR. PATIENTS AND METHODS: From October 2000 to October 2003 during the routine colonoscopy performed at one medical center, identified 152 non-polypoid colonic neoplasms in 149 patients (92 males, 57 females) were found. The mean patient age was 57.8 +/- 15.5 yr (range 32-80 yr). EMR was performed for lesions suspected of being neoplastic tumors via magnification colonoscopy with the indigo carmine dye spray method. The lesions were removed via EMR with pure cutting current after which hemoclips were applied to the resected wounds. RESULTS: The study identified 40 flat type lesions, 106 lateral spreading tumors, and 6 depressed lesions that were completely resected. The mean size of lesions was 19.4 +/- 10.3 mm (range 6-60 mm). Histological findings were 4 adenocarcinomas, 59 with high-grade adenoma/dysplasia, and 89 with low-grade adenoma/dysplasia. Two patients experienced bleeding immediately following EMR, while adequate hemostasis was achieved using hemoclips. Neither delayed bleeding nor perforation developed following EMR. CONCLUSION: EMR by using pure cutting current and hemoclip is a useful method for obtaining integral specimen for accurate pathologic assessment. This method provides a safe and minimally invasive technique managing of colonic non-polypoid lesions.

Adenoma↗
PubMed2005

Clinical and endoscopic features for alimentary tract cytomegalovirus disease: report of 20 cases with gastrointestinal cytomegalovirus disease.

BACKGROUND: The clinical presentations and endoscopic features of cytomegalovirus (CMV) infection in the gastrointestinal (GI) tract are diverse, and can mimic other inflammatory gastrointestinal diseases. METHODS: From 1987 to 2003 at Chang-Gung Medical Center, 20 patients with CMV infections of the GI tract who were assessed using endoscopic examinations and diagnosed via pathologic studies were retrospectively reviewed. RESULTS: Most of the patients were adults with immunocompromised conditions (10/20). GI tract bleeding was the most common clinical manifestation (11/20). Five patients presented with abdominal pain, and two patients presented with diarrhea. Fifteen patients suffered from fever. The endoscopic abnormalities could be classified into four main groups: inflammatory mucosa alone (3/20), ulceration alone (7/20), inflammatory mucosa associated with ulcer (9/20) and sub-mucosal tumor with ulcer (1/20). Of the 17 patients with ulcer lesions, ten had multiple ulcers and 12 had large ulcers exceeding 2 centimeters in diameter. Of the six patients followed up with colonoscopy, one was free of disease, one had a single ulcer, and four had colitis and were CMV positive on repeat biopsy. Two patients had colon strictures with persistent CMV colitis. CONCLUSION: Many patients with GI tract CMV infection are immunocompromised. Gastrointestinal bleeding is the most common initial presentation of gastrointestinal CMV disease. Fever is the most common associated toxic sign. Sigmoidoscopy cannot replace colonoscopy for detecting CMV colitis. The most common feature is multiple ulcers with at least one large ulcer. Endoscopic follow-up in patients with CMV colitis is recommended to investigate for possible persistent colitis and strictures.

Adolescent↗
PubMed2005

Treating colorectal polypoid neoplasms during a colonoscopy.

BACKGROUND: To evaluate the efficacy and outcomes of endoscopic treatment for colorectal polypoid neoplastic lesions. METHODS: From September 1999 to May 2003, 11,447 consecutive colonoscopic examinations were performed in 9864 patients, totaling 5355 endoscopic polypectomies for colorectal polypoid neoplasms. According to the macroscopic characteristics, the neoplasms were classified into protruded (n = 3953) and sessile (n = 1402) ones. A snare polypectomy was conducted on 3987 lesions and hot biopsy forceps removal on 1368 lesions. RESULTS: Histological diagnoses included 4456 neoplastic lesions (4282 adenomas and 174 adenocarcinomas) and 899 non-neoplastic lesions (889 hyperplastic and 10 inflamed polyps). For the adenocarcinoma group, 24 instances involved submucosal invasion or an unclear resection margin, and these patients received a further operation, while 11 surgical specimens disclosed no residual tumors. Three (0.05%) perforations and 96 (1.8%) instances of bleeding were found following endoscopic polypectomy. No procedure-related mortality was found, and no recurrent malignancy was found after 14 to approximately 56 months of follow-up. CONCLUSIONS: To lower the incidence of and mortality from colorectal cancer, endoscopic polypectomy for colorectal polypoid neoplasms is an effective and safe procedure.

Adenocarcinoma↗
PubMed2004

Multiple organ system failure in critically ill cirrhotic patients. A comparison of two multiple organ dysfunction/failure scoring systems.

OBJECTIVES: The prognosis for critically ill cirrhotic patients depends on the extent of hepatic and extrahepatic organ dysfunction/failure. We hypothesize that a graded multiple organ dysfunction score, sequential organ failure assessment (SOFA), would provide more descriptive and discriminative power for predicting the hospital mortality for critically ill cirrhotic patients than the classical organ system failure (OSF) score, which defines organ failure as an all-or-none phenomenon. METHODS: 160 patients diagnosed with liver cirrhosis were admitted to the medical intensive care unit (ICU) from January 2002 to June 2003. Information considered necessary for calculating the Child-Pugh, OSF and SOFA scores on ICU admission was collected prospectively. RESULTS: Hepatitis B infection was the most common cause of liver cirrhosis. A significantly progressive increase in mortality rate was associated with OSF and SOFA scores (p < 0.001). Close correlation between OSF and SOFA scores (p < 0.001) suggested that both systems evaluated the same event. In patients with similar organ dysfunction, the number of failed organ system(s) was significantly higher among non-survivors. However, no correlation existed between the SOFA scores and mortality rate in patients with the same OSF number. Meanwhile, both OSF and SOFA scores displayed excellent discriminative power (areas under receiver-operating characteristic (AUROC) were 0.906 and 0.892, respectively), while Child-Pugh scores clearly performed more poorly (AUROC 0.712). Both OSF and SOFA demonstrate a good fit using the Hosmer and Lemeshow goodness-of-fit test. CONCLUSIONS: Both OSF and SOFA scores are excellent tools for predicting prognosis for cirrhotic patients admitted to ICU. Both of them are superior to Child-Pugh score. Hospital mortality for critically ill cirrhotic patients occurs owing to severe failure of a relatively few organs, rather than because of an accumulation of mild dysfunction in many organ systems. Graded organ dysfunction scales provide no further benefit for predicting hospital mortality for critically ill cirrhotic patients.

Adult↗
PubMed2004

Magnifying endoscopy with indigo carmine contrast for differential diagnosis of neoplastic and nonneoplastic colonic polyps.

This study describes the feasibility of magnifying colonoscopy with indigo carmine dye contrast to distinguish neoplastic and nonneoplastic colonic polyps. This study sampled consecutive patients undergoing colonoscopy using an Olympus CF240ZI from January to October 2000 at Chang-Gung Memorial Hospital, Lin-Kou Medical Center. This study analyzed a total of 270 polyps. Indigo carmine (0.2%) was sprayed directly on the mucosa surface before observing the crypts using a magnifying colonoscope (1.5x-100x). The pit patterns were described using the classification proposed by Kudo. Finally, polypectomy or biopsy was performed for histological diagnosis. The study identified 155 adenomas, 99 hyperplastic polyps, 9 adenocarcinomas, and 7 other nonneoplastic lesions (harmatoma, inflammatory polyps, and mucosal tag). The pit pattern was analyzed for all lesions. Further classification into neoplastic (adenoma and adenocarcinoma) and nonneoplastic (hyperplastic and others) polyps revealed 156 neoplastic and 14 nonneoplastic polyps among the type III to type V pits and 92 nonneoplastic and 8 neoplastic polyps among the type I and II pits. The sensitivity of type III to type V pits in detecting neoplastic polyps was 95.1%, with a specificity of 86.8% and diagnostic accuracy of 91.9%. The positive likelihood ratio was 7.3, and the negative likelihood ratio was 0.06. Magnifying colonoscopy with indigo carmine dye contrast provides morphological detail that correlates well with polyp histology. Small flat lesions with typical type II pit pattern should have minimal neoplastic risk, thus endoscopic resection is not necessary.

Adenocarcinoma↗
PubMed2004

Endoscopic management of Dieulafoy lesions in acute nonvariceal upper gastrointestinal bleeding.

Dieulafoy lesion is an unusual but important cause of upper gastrointestinal bleeding. The study retrospectively reviewed 29 patients (2.1%) with Dieulafoy lesions of 1393 acute nonvariceal upper gastrointestinal bleeding episodes from October 1999 to May 2001. Nineteen patients (66%) were male and the median age was 62 years (range, 19 to 86 years). Two patients underwent emergent surgery after endoscopic diagnosis. The other patients were allocated to four therapeutic endoscopic groups: group I, epinephrine injection (11 patients); group II, epinephrine injection plus heater probe coagulation (10 patients); group III, histoacryl injection (4 patients); and group IV, hemoclipping (2 patients). Initial treatment failure ocurred in three patients (all in group I) and they received surgery, hemoclipping, or band ligation as salvage therapy, respectively. Among those who achieved initial hemostasis, recurrent bleeding developed in two patients (all in group I) and was successfully controlled by endoscopic injection plus thermal therapy. No complication was noted after endoscopic treatment. Group II had a significantly higher successful hemostasis rate than group I (100 vs 54%; P = 0.02). One patient in the therapeutic endoscopy groups died during admission, for a mortality rate of 3.7%. Patients were followed up from 6 to 36 months and no further bleeding was noted. The results suggest that epinephrine injection plus heater probe coagulation was significantly superior to epinephrine injection alone in achieving hemostasis. Histoacryl injection, hemoclipping, and endoscopic band ligation were safe and effective alternate therapies.

Acute Disease↗
PubMed2003

Endoscopic hemorrhoidal ligation of symptomatic internal hemorrhoids.

BACKGROUND: This study assessed the efficacy of endoscopic hemorrhoidal ligation for treatment of patients with symptoms caused by internal hemorrhoids. METHODS: A total of 576 consecutive patients with symptoms caused by internal hemorrhoids were enrolled in the study. Symptoms were rectal bleeding (239 patients) and prolapse (337 patients). The severity of the hemorrhoids was classified by using the grading system of Goligher. RESULTS: All patients were treated by the same operator. Mean follow-up was 17.5 months (range 8 to 24 months). The mean number of band ligations per session was 2.86. The mean number of treatment sessions was 1.24. At least one grade reduction in the severity of the hemorrhoids was achieved in most patients (93.58%). Moreover, rectal bleeding was controlled in 228 patients (95.4%), and rectal prolapse was reduced in 310 patients (91.99%). After treatment, 85 patients experienced anal pain, 37 had mild bleeding, 4 developed external hemorrhoidal thrombosis, and one had a peri-anal abscess. The latter 5 patients were treated surgically and recovered uneventfully. CONCLUSIONS: Endoscopic hemorrhoidal ligation is a simple, safe, and effective treatment for patients with symptoms caused by internal hemorrhoids.

Endoscopy, Gastrointestinal↗
PubMed2003

Simplified 13C-urea breath test with a new infrared spectrometer for diagnosis of Helicobacter pylori infection.

BACKGROUND AND AIM: Infrared spectrometry has correlated excellently with mass spectrometry in detecting the ratio of 13CO(2) to 12CO(2) in breath samples. The present study aimed to evaluate the accuracy of the 13C-urea breath test (13C-UBT) using a new model of infrared analyzer. METHODS: A total of 600 patients who were undergoing upper endoscopy without receiving eradication therapy were entered into the study. Culture, histology, and rapid urease test on biopsies from the antrum and corpus of the stomach were used for the determination of Helicobacter pylori infection. Breath samples were collected before and 20 min after drinking 100 mg 13C-urea in 100 mL water. The optimal cutoff value was determined by the receiver operating characteristic curve. RESULTS: Of the 586 patients who were eligible for analysis, 369 were positive for H. pylori infection, 185 were negative for H. pylori infection, and 32 were indeterminate. When the appropriate cutoff value was set at 3.5 per thousand, a sensitivity of 97.8%, a specificity of 96.8% and an accuracy of 97.5% were obtained using the 13C-UBT. The accuracy of the 13C-UBT decreased when CO(2) concentration in the breath sample was <2%, as compared with > or = 2% (93.6%vs 97.7%), mainly because of a decrease in specificity (81.8%vs 97.7%). There were 2.7% of patients with Delta13CO(2) values that fell between 3.0-4.5 per thousand, in whom the risk of error was 47%. CONCLUSIONS: The 13C-UBT performed with infrared spectrometry is a highly sensitive, specific, and non-invasive method for the detection of H. pylori infection. The immediate availability of the test result and technical simplicity make it particularly effective in routine clinical practice.

Adult↗
PubMed2003

Organ system failure scoring system can predict hospital mortality in critically ill cirrhotic patients.

GOALS: This study was conducted to assess and compare the accuracy of Child-Pugh classification and organ system failure (OSF) scores, obtained on the first day of ICU admission, in predicting the hospital mortality in critically ill cirrhotic patients. BACKGROUND: Cirrhotic patients admitted to the medical intensive care unit (ICU) are associated with high mortality rates. The prognosis of critically ill cirrhotic patients is determined by the extent of hepatic and extrahepatic organ dysfunction. STUDY: A total of 111 patients diagnosed with liver cirrhosis were admitted to medical ICU from July 2001 to June 2002. Information considered necessary to compute the Child-Pugh and OSF scores on the first day of ICU admission was prospectively collected. RESULTS: The overall hospital mortality rate was 64.9%. Liver disease was most commonly attributed to hepatitis B viral infection. The OSF scores demonstrate a good fit using the Hosmer and Lemeshow goodness-of-fit test. Meanwhile, by using the areas under receiver operating characteristic (AUROC) curve, the OSF scores demonstrated an excellent discriminative power (AUROC 0.901), whereas the performance of Child-Pugh scores is clearly poorer (AUROC 0.748). CONCLUSION: This investigation confirms that the prognosis for cirrhotic patients admitted to ICU is grave. The OSF score is a simple, reproducible, and easily applied tool with excellent prognostic abilities that can provide objective information for patients' families and physicians and supplement the clinical judgment of prognosis.

Aged↗