EASL-CLIF criteria outperform NACSELD criteria for diagnosis and prognostication in ACLF

Li, Feng; Thuluvath, Paul J.

doi:10.1016/j.jhep.2021.05.033

Cited by 23 publications

(24 citation statements)

References 13 publications

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“…The UNOS dataset did not have information about PaO2, FIO2, or mean arterial pressure (MAP), and we had to use the predefined variables in the UNOS dataset for the respiratory and circulatory system failure. We do not believe that the availability of those data would have made any meaningful differences in our observations[ 10 ].…”

Section: Discussionmentioning

confidence: 99%

“…Although more than 13 different definitions of acute-on-chronic liver failure (ACLF) have been proposed, the three commonly used criteria were those proposed by the Asian Pacific Association for Study of Liver Diseases (APASL), the European Association for the Study of the Liver-Chronic Liver Failure Consortium (EASL-CLIF) and the North American Consortium for the Study of End-Stage Liver Disease (NACSELD)[ 5 - 9 ]. In a recent study, we have clearly shown that EASL-CLIF criteria have a better sensitivity and a better ability to predict short-term, all-cause, and transplant-free mortality when compared to the NACSELD criteria[ 10 ]. In that study, only 15.3% of those with EASL-CLIF ACLF grade 1-3 met ACLF by NACSELD criteria.…”

Section: Introductionmentioning

confidence: 99%

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Modified EASL-CLIF criteria that is easier to use and perform better to prognosticate acute-on-chronic liver failure

Thuluvath¹,

Li²

2022

WJH

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BACKGROUND We have recently shown that the European Association for the Study of the Liver-Chronic Liver Failure Consortium (EASL-CLIF) criteria showed a better sensitivity to detect acute-on-chronic liver failure (ACLF) with a better prognostic capability than the North American Consortium for the Study of End-Stage Liver Disease criteria. AIM To simplify EASL-CLIF criteria for ease of use without sacrificing its sensitivity and prognostic capability. METHODS Using the United Network for Organ Sharing data (January 11, 2016, to August 31, 2020), we modified EASL-CLIF (mEACLF) criteria; the modified mEACLF criteria included six organ failures (OF) as in the original EASL-CLIF, but renal failure was defined as creatinine ≥ 2.35 mg/dL and coagulation failure was defined as international normalized ratio (INR) ≥ 2.0. The mEACLF grades (0, 1, 2, and ≥ 3) directly reflected the number of OF. RESULTS Of the 40357 patients, 14044 had one or more OF, and 9644 had ACLF grades 1-3 by EASL-CLIF criteria. By the mEACLF criteria, 15574 patients had one or more OF. The area under the receiver operating characteristic (AUROC) for 30-d all-cause mortality by OF was 0.842 (95%CI: 0.831-0.853) for mEACLF and 0.835 (95%CI: 0.824-0.846) for EASL-CLIF ( P = 0.006), and AUROC for 30-d transplant-free mortality by OF was 0.859 (95%CI: 0.849-0.869) for mEACLF and 0.851 (95%CI: 0.840-0.861) for EASL-CLIF ( P = 0.001). The AUROC of 30-d all-cause mortality by ACLF grades was 0.842 (95%CI: 0.831-0.853) for mEACLF and 0.793 (95%CI: 0.781-0.806) for EASL-CLIF ( P < 0.0001). The AUROC of 30-d transplant-free mortality by ACLF was 0.859 (95%CI: 0.848-0.869) for mEACLF and 0.805 (95%CI: 0.793-0.817) for EASL-CLIF ( P < 0.0001). CONCLUSION Our study showed that EASL-CLIF criteria for ACLF grades could be simplified for ease of use without losing its prognostication capability and sensitivity.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Modified EASL-CLIF criteria that is easier to use and perform better to prognosticate acute-on-chronic liver failure

Thuluvath¹,

Li²

2022

WJH

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“…Conversely, a patient on dialysis receiving bilevel positive airway pressure has NACSELD ACLF, but would not be classified as such using the UNOS data. ( 4 )…”

Section: Ability To Use Unos Data To Study Aclfmentioning

confidence: 99%

Acute‐on‐Chronic Liver Failure and Liver Transplantation: Putting the Cart Before the Horse in Data Analyses and Advocating for Model for End‐Stage Liver Disease Exceptions

Goldberg

Bajaj

2021

Liver Transpl

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Acute-on-chronic liver failure (ACLF) is a clinical entity defined by organ failures and high short-term mortality rates. However, unlike other diseases that are defined by histology or serology, ACLF was first defined based on the requirement of a high 28-day mortality rate using a predefined threshold. (1) Despite multiple definitions of ACLF, all require a combination of laboratory and clinical data (eg, prior decompensations), some of which are only available in the medical record. There have been a series of publications using US transplantation registry data from the United Network for Organ Sharing (UNOS) to advocate for changes in transplantation policy for patients with ACLF. (2) In this editorial, we discuss the barriers to using transplantation registry data to study ACLF. aBilitY to USE UNoS data to StUdY aClFUNOS data are submitted by transplantation centers and organ procurement organizations to place patients on the waiting list, match donors and recipients, and monitor posttransplantation outcomes. Their use as a research database is secondary. ACLF studies using the UNOS registry have most commonly relied on the European (European Association for the Study of the Liver-Chronic Liver Failure [EASL-CLIF]) and/or North American (North American Consortium for the Study of End-Stage Liver Disease [NACSELD]) criteria. Importantly, both criteria require the presence of acutely decompensated cirrhosis and organ failures. (3,4) Acutely Decompensated CirrhosisUNOS only includes data on 2 decompensations, ascites and hepatic encephalopathy (HE), at waitlisting and transplantation. With respect to patients who are "acutely decompensated," UNOS only collects data on the presence/absence and severity, without consideration of timing (ie, acute decompensation versus chronic condition). Organ FailuresEASL-CLIF criteria include hepatic and extrahepatic organ failures in the classified and staged ACLF grades, whereas NACSELD criteria are based only on extrahepatic organ failures (Table 1). Of the 6 EASL-CLIF organ failures, 3 (liver, renal, and coagulation)

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“…In a validation study of NACSELD definition of ACLF, in which 2675 patients with AD of cirrhosis related or not to infection were included, the prevalence of ACLF was 10% and 30-day mortality rate was significantly different between patients with or without the syndrome (41% vs. 7%, respectively) [14]. In a recent study, the NACSELD criteria were demonstrated to be less sensitive compared to EASL-CLIF criteria in diagnosing ACLF [15].…”

Section: Clinical Featuresmentioning

confidence: 99%

Acute-on-Chronic Liver Failure in Cirrhosis

Gambino

Piano

Angeli

2021

JCM

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Acute-on-chronic liver failure (ACLF) is a syndrome that develops in patients with acutely decompensated chronic liver disease. It is characterised by high 28-day mortality, the presence of one or more organ failures (OFs) and a variable but severe grade of systemic inflammation. Despite the peculiarity of each one, every definition proposed for ACLF recognizes it as a proper clinical entity. In this paper, we provide an overview of the diagnostic criteria proposed by the different scientific societies and the clinical characteristics of the syndrome. Established and experimental treatments are also described. Among the former, the most relevant are directed to support organ failures, treat precipitating factors and carry out early assessment for liver transplantation (LT). Further studies are needed to better clarify pathophysiology of the syndrome and discover new therapies.

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EASL-CLIF criteria outperform NACSELD criteria for diagnosis and prognostication in ACLF

Cited by 23 publications

References 13 publications

Modified EASL-CLIF criteria that is easier to use and perform better to prognosticate acute-on-chronic liver failure

Modified EASL-CLIF criteria that is easier to use and perform better to prognosticate acute-on-chronic liver failure

Acute‐on‐Chronic Liver Failure and Liver Transplantation: Putting the Cart Before the Horse in Data Analyses and Advocating for Model for End‐Stage Liver Disease Exceptions

Acute-on-Chronic Liver Failure in Cirrhosis

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