Prognostic performance of clinical indices and model scorings for acute-on-chronic liver failure: A study of 164 patients

Abstract

Abstract.The present study aimed to analyze the prognostic factors of acute-on-chronic liver failure (ACLF), with the perspective of an improved selection of optimal therapeutic schemes. A retrospective analysis was used to study 164 patients with ACLF hospitalized between 2010 and 2014 in a single center. Patients were divided into favorable and unfavorable groups, according to the treatment outcomes. General characteristics and clinical manifestations were analyzed to determine whether they would affect the prognosis of the patients with ACLF, with a particular focus on the scoring systems Child-Pugh, model for end-stage liver disease (MELD), MELD with incorporation of sodium (MELD-Na), MELD and serum sodium ratio (MESO) and integrated MELD (iMELD). Hepatitis B virus infection was the predominant cause of ACLF, accounting for 88 cases (53.7%). Age, prothrombin time, thrombin time, international normalized ratio (INR), prothrombin activity, serum sodium, albumin, total bilirubin, serum creatinine, platelets, fasting blood sugar, infections, hepatic encephalopathy, hepatorenal syndrome (HRS), and electrolyte disorder were revealed to be associated with prognosis. Age, serum sodium, INR, HRS, and infection were independent prognostic risk factors, as determined by multivariate analysis. Child-Pugh, MELD, MELD-Na, MESO and iMELD scoring systems all demonstrated adequate predictive values, with MELD-Na as the most effective scoring system. In conclusion, age, hyponatremia, INR, HRS and bacterial or fungal infections were reported to be independent prognostic risk factors for ACLF. Among the various liver function scoring systems, MELD-Na was the most accurate in predicting the prognosis of ACLF.

Prognostic factors of the short-term outcomes of patients with hepatitis B virus-associated acute-on-chronic liver failure

“…Comparisons of the predictive abilities of the CTP, MELD, MELD-Na, iMELD and ALBI scoring systems for the prognosis of HBV-ACLF are rarely reported. Attempts to analyze the impact of clinical parameters and the combined prognostic abilities of these parameters on ACLF prognosis have provided inconsistent results due to differences in study subjects, study phases and follow-up periods 13 - 15 . The integration of general information, clinical indicators and a prognostic scoring system may better predict the short-term outcomes of patients with HBV-ACLF.…”

Hepatitis B and Delta: clinical aspects of patients in the Brazilian Western Amazonia

“…In the whole sample, 33% of the patients showed an altered PT/INR, without significant differences between the groups studied. The PT/INR, besides evaluating the blood coagulation factor, also assists in estimating risks for acute or chronic liver failure (26) . ALT and AST levels indicated greater proportion among patients superinfected with HDV.…”

Acute-on-chronic liver failure: recent update

“…MELD score has been shown to be a valid predictor of long-term survival in patients with cirrhosis, as well as other areas beyond end-stage liver disease such as variceal bleeding, fulminant hepatic failure, alcoholic hepatitis and hepatocellular carcinoma [ 18 – 22 ] However, its role as a prognostic scoring system for patients with ACLF is still disputed. Various studies have found that MELD score alone cannot predict the postoperative mortality or morbidity for patients with ACLF, indicating the necessity for an effective scoring system to determine which patients can benefit from liver transplantation [ 23 – 26 ] Despite this, evidence exists to suggest that MELD score may have some utility as a prognostic marker in ACLF. A Chinese modified MELD was found to reveal poor prognosis in pre-ACLF patients [ 27 ] The prognostic model identified 5 independent factors associated with survival among patients with pre-ACLF and ACLF: MELD score, age, hepatic encephalopathy, triglyceride level and platelet count.…”