Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure

Jalan, Rajiv; Saliba, Faouzi; Pavesi, Marco; Amorós, Àlex; Moreau, Richard; Ginès, Pere; Levesque, Éric; Durand, François; Angeli, Paolo; Caraceni, Paolo; Hopf, C.; Alessandria, Carlo; Rodríguez, Ezequiel; Solís‐Muñoz, Pablo; Laleman, Wim; Trebicka, Jonel; Zeuzem, Stefan; Gustot, Thierry; Mookerjee, Rajeshwar P.; Elkrief, Laure; Soriano, Germán; Córdoba, Joan; Morando, Filippo; Gerbes, Alexander L.; Agarwal, Banwari; Samuel, Didier; Bernardi, Mauro; Arroyo, Vicente

doi:10.1016/j.jhep.2014.06.012

Cited by 783 publications

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“…This is similar to CANONIC study where multiorgan failure was determinant of mortality in ACLF in a population where majority of acute insults were extrahepatic. 2,22 Despite these differences, the 28-and 90-day mortalities were comparable between the groups. In contrast, a Chinese study showed comparable 28-day mortality (50.7% vs. 48.3%, P = 0.22) but increased 90-day mortality in extrahepatic ACLF than hepatic ACLF group (68.3% vs. 58.9%, P = 0.035).…”

Section: Discussionmentioning

confidence: 88%

Impact of Hepatic and Extrahepatic Insults on the Outcome of Acute-on-Chronic Liver Failure

Gupta

Dhiman

Rathi

et al. 2017

Journal of Clinical and Experimental Hepatology

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Background: To study the differences in outcome and predictors of mortality in acute-on-chronic liver failure (ACLF) precipitated by hepatic or extrahepatic insults. Methods: Consecutive patients of cirrhosis with acute decompensation were prospectively included and followed up for 90 days from admission. ACLF was defined based on chronic liver failure (CLIF) acute-on-chronic liver failure in cirrhosis (CANONIC study) criteria. Acute worsening due to acute viral hepatitis A and E, hepatitis B flare, alcoholic hepatitis, autoimmune hepatitis flare, or drug-induced liver injury were categorized as hepatic ACLF and that due to bacterial infection, upper gastrointestinal bleed or surgery as extrahepatic ACLF. Patients with both hepatic and extrahepatic insults were included in combined insult group. Results: Of 179 patients of acute decompensation, 122 had ACLF (hepatic insults 47 and extrahepatic insults 51). Alcohol (64.8%) was the most common etiology of cirrhosis while infection (36%) was the most common acute insult followed by alcoholic hepatitis (24.6%). Higher proportion of extrahepatic ACLF patients had history of prior decompensation than hepatic ACLF patients (62.7% vs. 27.7%, P < 0.001). There was no difference in mortality among hepatic and extrahepatic ACLF groups at 28 and 90 days (53.2% vs. 56.9%, P = 0.715 and 85% vs. 74.5%, P = 0.193, respectively). Area under receiver-operating curve (AUROC) for 28-day mortality in extrahepatic ACLF group was 0.788, 0.724, 0.718, 0.634, and 0.726 and in hepatic-ACLF group was 0.786, 0.625, 0.802, 0.761, and 0.648 for chronic liver failure-sequential organ failure assessment (CLIF-SOFA), model for end stage liver disease (MELD), integrated MELD score (iMELD), acute physiology and chronic health evaluation score (APACHE-II), and Child-Turcotte-Pugh score scores, respectively. Conclusion: There is no difference in mortality among hepatic and extrahepatic ACLF groups at 28 and 90 days. iMELD and CLIF-SOFA have highest AUROC to predict 28-day mortality in hepatic and extrahepatic ACLF groups, respectively. ( J CLIN EXP HEPATOL 2017;7:9-15)

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Section: Discussionmentioning

confidence: 88%

Impact of Hepatic and Extrahepatic Insults on the Outcome of Acute-on-Chronic Liver Failure

Gupta

Dhiman

Rathi

et al. 2017

Journal of Clinical and Experimental Hepatology

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“…This score derived from SOFA assess six organ systems (liver, kidneys, brain, coagulation, circulation, lungs) and takes in account the specificity of cirrhosis [21].…”

Section: Data Collectionmentioning

confidence: 99%

Modification in CSF specific gravity in acutely decompensated cirrhosis and acute on chronic liver failure independent of encephalopathy, evidences for an early blood-CSF barrier dysfunction in cirrhosis

et al. 2016

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“…For the diagnosis of organ failure, the CLIF-SOFA score (Chronic Liver Failure -Sequential Organ Failure Assessment) has been used (3). Recently, two new scores were developed and validated in ACLF patients admitted to tertiary centers: a diagnostic score (Chronic Liver Failure Consortium -Organ Failure [CLIF-C OF]) and a prognostic score (Chronic Liver Failure ConsortiumAcute-on-Chronic Liver Failure [CLIF-C ACLF]) (4). ACLF justifies most admissions of cirrhotic patients to intensive care units (ICU) (5).…”

Section: Introductionmentioning

confidence: 99%

CLIF-C ACLF score is a better mortality predictor than MELD, MELD-Na and CTP in patients with Acute on Chronic Liver Failure admitted to the ward

et al. 2017

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Background and aims: Acute-on-chronic liver failure (ACLF) is a frequent syndrome associated with high mortality. The aims of the present study are: a) comparing the Chronic Liver Failure Consortium (CLIF-C) ACLF Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na) and Child-TurcottePugh (CTP) scores for prediction of short/medium term mortality; b) identifying ACLF prevalence in patients admitted to the ward; and c) comparing mortality between non-ACLF/ACLF.Methods: Retrospective cohort study of 177 patients admitted to the Gastroenterology ward for acute decompensation of cirrhosis.Results: We included 132 males. Alcohol was the cirrhosis cause/co-factor in 79.7% of cases. Infection was present in 40.7%. At admission, 19.8% of patients presented ACLF and 7.9% developed it during hospitalization (overall prevalence was 27.7%). ACLF grade 1 was diagnosed in 55.1% of the ACLF patients; grade 2, in 42.8%, and grade 3, in 2.0%. Infection (p < 0.001) and hepatic encephalopathy (p = 0.004) were more prevalent and C-reactive protein and leukocyte counts were higher in ACLF patients. ACLF 28 and 90-day mortality was 45.8% and 60.4%, respectively. The CLIF-C ACLF score was significantly superior to CTP, MELD, MELD-Na in predicting 28-day (AUROC 0.799 ± 0.078, 95% CI 0.637-0.891) and 90-day mortality (AUROC 0.828 ± 0.063, 95% CI 0.705-0.952).Conclusion: ACLF is highly prevalent in the ward. The new CLIF scores identify high mortality cirrhotic patients admitted to the ward and are better than their predecessors to predict ACLF patients' short/medium term mortality.

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Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure

Abstract: The CLIF-C ACLFs at ACLF diagnosis is superior to the MELDs and MELD-Nas in predicting mortality. The CLIF-C ACLFs is a clinically relevant, validated scoring system that can be used sequentially to stratify the risk of mortality in ACLF patients.

Cited by 783 publications

References 19 publications

Impact of Hepatic and Extrahepatic Insults on the Outcome of Acute-on-Chronic Liver Failure

Impact of Hepatic and Extrahepatic Insults on the Outcome of Acute-on-Chronic Liver Failure

Modification in CSF specific gravity in acutely decompensated cirrhosis and acute on chronic liver failure independent of encephalopathy, evidences for an early blood-CSF barrier dysfunction in cirrhosis

CLIF-C ACLF score is a better mortality predictor than MELD, MELD-Na and CTP in patients with Acute on Chronic Liver Failure admitted to the ward

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