Chronic liver failure-consortium acute-on-chronic liver failure and acute decompensation scores predict mortality in Brazilian cirrhotic patients

Abstract

AIMTo validate prognostic scores for acute decompensation of cirrhosis and acute-on-chronic liver failure in Brazilian patients.METHODSThis is a prospective cohort study designed to assess the prognostic performance of the chronic liver failure-consortium (CLIF-C) acute decompensation score (CLIF-C AD) and CLIF-C acute-on-chronic liver failure score (CLIF-C ACLF), regarding 28-d and 90-d mortality, as well as to compare them to other prognostic models, such as Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na), Child-Pugh (CP) score, and the CLIF-C Organ Failure score (CLIF-C OF). All participants were adults with acute decompensation of cirrhosis admitted to the Emergency Department of a tertiary hospital in southern Brazil. Prognostic performances were evaluated by means of the receiver operating characteristic (ROC) curves, area under the curves (AUC) and 95%CI.RESULTSOne hundred and thirteen cirrhotic patients were included. At admission, 18 patients had acute-on-chronic liver failure (ACLF) and 95 individuals had acute decompensation (AD) without ACLF, of which 24 eventually developed ACLF during the course of hospitalization (AD evolving to ACLF group). The AD group had significantly lower 28-d (9.0%) and 90-d (18.3%) mortality as compared to the AD evolving to ACLF group and to the ACLF group (both P < 0.001). On the other hand, 28-d and 90-d mortalities were not significantly different between AD evolving to ACLF group and ACLF group (P = 0.542 and P = 0.708, respectively). Among patients with ACLF, at 28 d from the diagnosis, CLIF-C ACLF was the only score able to predict mortality significantly better than the reference line, with an AUC (95%CI) of 0.71 (95%CI: 0.54-0.88, P = 0.021). Among patients with AD, all prognostic scores performed significantly better than the reference line regarding 28-d mortality, presenting with similar AUCs: CLIF-C AD score 0.75 (95%CI: 0.63-0.88), CP score 0.72 (95%CI: 0.59-0.85), MELD score 0.75 (95%CI: 0.61-0.90), MELD-Na score 0.76 (95%CI: 0.61-0.90), and CLIF-C OF score 0.74 (95%CI: 0.60-0.88). The same occurred concerning AUCs for 90-d mortality: CLIF-C AD score 0.70 (95%CI: 0.57-0.82), CP score 0.73 (95%CI: 0.62-0.84), MELD score 0.71 (95%CI: 0.59-0.83), MELD-Na score 0.73 (95%CI: 0.62-0.84), and CLIF-C OF score 0.65 (95%CI: 0.52-0.78).CONCLUSIONThis study demonstrated that CLIF-C ACLF is the best available score for the prediction of 28-d mortality among patients with ACLF. CLIF-C AD score is also useful for the prediction of mortality among cirrhotic patients with AD not fulfilling diagnostic criteria for ACLF, but it was not superior to other well-established prognostic scores.

Comparison of General and Liver-Specific Prognostic Scores in Their Ability to Predict Mortality in Cirrhotic Patients Admitted to the Intensive Care Unit

“…CLIF-C AD was also developed by the CANONIC group of investigators [ 28 ], using the following parameters: age, INR, serum creatinine, and leukocyte count. Other [ 53 – 55 ], but not all [ 50 ], studies have disclosed similar findings. Our results report a good ability of CLIF-C AD to predict in-hospital mortality in cirrhotic patients admitted to the ICU with AD of cirrhosis, per definition without ACLF.…”

“…Those differences may be due to comparison of heterogeneous cohorts comprised of patients from different genetic backgrounds and more importantly with differing percentages of organ failures. Another key point to better understand these discrepancies is to recognize that most of those studies, evaluating the accuracy of the prognostic scores, used distinct time intervals to assess outcomes, including in-ICU [ 25 ], in-hospital [ 40 , 42 , 45 , 46 ], 28-day [ 49 , 50 ], 6-week [ 9 ], and 90-day mortality [ 50 ]. Few studies have assessed accuracy of general ICU and liver-specific prognostic scores in critically ill patients with cirrhosis according to the presence of ACLF [ 16 , 41 , 51 , 52 ], and none of them have compared the accuracy of those scores to predict in-hospital mortality.…”

Meta-analysis of individual patient data of albumin dialysis in acute-on-chronic liver failure: focus on treatment intensity

“…ACLF has no specific treatment other than the management of the associated complications of cirrhosis and organ support and is a major worldwide healthcare problem. 1,[15][16][17][18] Initial investigations suggested that ALS systems, and MARS, in particular, provided clinical benefit, but this was not confirmed by subsequent RCTs. [7][8][9] These later studies, which were performed prior to the CANONIC study, showed that MARS significantly improved liver, renal, and cerebral functions but it did not result in survival benefit.…”

Предиктори Короткострокової Смертності У Хворих На Гепаторенальний Синдром

“…Моніторинг цих показників дозволяє визначити групу пацієнтів з найгіршим прогнозом та поставити їх на перше місце у списку для трансплантації печінки. In regards to this approach, the new score was developed to estimate the risk of short-term mortality (within the first 28 days after admission to the hospital) in patients with sudden deterioration of the chronic liver disease -CLIF-C-ACLF score (Chronic Liver Failure Consortium of Acute-on-Chronic Liver Failure) [8][9][10][11][12][13][14] . However, these scales are complex to use as they contain many indicators to predict the short-term mortality in patients who were treated for HRS.…”