A Modified MELD Model for Chinese Pre-ACLF and ACLF Patients and It Reveals Poor Prognosis in Pre-ACLF Patients

Abstract

Background & AimsAcute-on-chronic liver failure (ACLF) is one of the most deadly, prevalent, and costly diseases in Asia. However, no prognostic model has been developed that is based specifically on data gathered from Asian patients with ACLF. The aim of the present study was to quantify the survival time of ACLF among Asians and to develop a prognostic model to estimate the probability of death related to ACLF.MethodsWe conducted a retrospective observational cohort study to analyze clinical data from 857 patients with ACLF/pre-ACLF who did not undergo liver transplantation. Kaplan–Meier and Cox proportional hazards regression model were used to estimate survival rates and survival affected factors. The area under the receiver operating characteristic curve (auROC) was used to evaluate the performance of the models for predicting early mortality.ResultsThe mortality rates among patients with pre-ACLF at 12 weeks and 24 weeks after diagnosis were 30.5% and 33.2%, respectively. The mortality rates among patients with early-stage ACLF at 12 weeks and 24 weeks after diagnosis were 33.9% and 37.1%, respectively. The difference in survival between pre-ACLF patients and patients in the early stage of ACLF was not statistically significant. The prognostic model identified 5 independent factors significantly associated with survival among patients with ACLF and pre-ACLF: the model for end-stage liver disease (MELD) score; age, hepatic encephalopathy; triglyceride level and platelet count.ConclusionThe findings of the present study suggest that the Chinese diagnostic criteria of ACLF might be broadened, thus enabling implementation of a novel model to predict ACLF-related death after comprehensive medical treatment.

A novel integrated Model for End‐Stage Liver Disease model predicts short‐term prognosis of hepatitis B virus‐related acute‐on‐chronic liver failure patients

“…Using the Cox proportional hazard model, we identified the characteristics of the majority of patients who would not immediately recover from the insults. Those patients were characterized by old age, severe hepatic damage (high MELD score) and high occurrence of HE, which was consistent with previous reports . Age as an independent risk factor in ACLF was not surprising as patients of older age usually had a higher frequency of comorbidity, longer duration of underlying disease and poor hepatic regeneration in response to acute insults.…”

“…Those patients were characterized by old age, severe hepatic damage (high MELD score) and high occurrence of HE, which was consistent with previous reports. 19,20 Age as an independent risk factor in ACLF was not surprising as patients of older age usually had a higher frequency of comorbidity, longer duration of underlying disease and poor hepatic regeneration in response to acute insults. Our results demonstrated that HE was another independent risk factor integrated into the MELD-sodium model.…”

Acute-on-chronic liver failure: A prospective study to determine the clinical profile, outcome, and factors predicting mortality

“…This perhaps suggests that the ACLF by APASL includes probably a cohort of pre-ACLF patients, who not necessarily have a high immediate mortality or in whom a timely intervention prevents development of significant organ failures other than liver failure, thereby reducing the chances of mortality. Also, CLIF-SOFA score had a higher sensitivity in predicting mortality as compared to both MELD and CTP score, though some of the previous studies have found MELD score to be equally good in predicting mortality [17].…”

Increased delayed mortality in patients with acute‐on‐chronic liver failure who have prior decompensation

“…Overt ascites was diagnosed by clinical examination and ultrasonography as previously described . HE was defined as an episode of neurological and neuropsychiatric abnormality …”