THU-040-AARC score: A dynamic model to predict outcome in acute on chronic liver failure patients

Kumar, K.; Choudhury, Ashok; Mahtab, Mamun Al; Rahman, Salimur; K., Alam, Mohd Shahinul, Chuang, Wan-Long, Anand, Lovkesh, Sharma, Manoj; Devarbhavi, Harshad; Chawla, YK; Dhiman, RK; Duseja, Ajay; Taneja, Sunil; Sarin, Shiv Kumar; Paulson, Irene; Jain, Priyanka; Kumar, Guresh; Goel, Ashish; Eapen, CE; Sood, Ajit; Midha, Vandana; Shukla, Akash; Shah, Samir; Kalal, Chetan

doi:10.1016/s0618-8278(19)30323-8

Cited by 2 publications

(3 citation statements)

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“…Similar results have been demonstrated by previous studies where MELD is observed superior to CTP and SOFA. 21,26,33,34 Flabbergasting, the CLIF-SOFA, which is considered superior to the above ones in predicting mortality, 34,35 stays way behind in this study. X , median; n, count, x, mean, σ, SD.…”

Section: Discussionmentioning

confidence: 73%

“…similar observations in their respective studies. 21,33,36 MELD and CTP determine the severity of the underlying liver disease, whereas SOFA and CLIF-SOFA assess the extent of extra-hepatic organ involvement. It is quite obvious that organ failure resulting from any disease correlates proportionately with mortality; ACLF, acute severe decompensation of the liver, also results in organ failure and subsequent death.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of early mortality among patients with acute‐on‐chronic liver failure

Valantine

Sundaray

Mishra³

et al. 2021

JGH Open

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Background and Aim: Acute-on-chronic liver failure (ACLF) is a transpiring entity, which possesses high short-term/early mortality (28 days). Several mortality predictors have been studied, but none were proved reliable. Serum ferritin, an acute phase reactant and marker of hepatic necro-inflammation, is found to predict mortality in multiple liver diseases. We aimed to evaluate the role of serum ferritin and other clinical features, biochemical parameters and conventional scoring systems in predicting early mortality among ACLF. Methods: A prospective cohort study was done from October 2017 to March 2019 at a tertiary care (non-transplant) center in eastern India. A total of consecutive 50 ACLF patients diagnosed, based on Asia Pacific Association for the Study of liver disease definition, were investigated for ferritin and other laboratory parameters on day-0, day-7, and followed up for 28 days. Results: Although the majority did not have organ failure (ACLF grade 0) according to European Association for Study of Liver-chronic liver failure sequential organ failure assessment criteria, early mortality was high (56%). On undergoing univariate analysis, multiple variables (ascites, HE, creatinine, total leucocyte count (TLC), bilirubin, albumin) predicted mortality. However, on multivariate analysis, only total bilirubin independently predicted. None of the scores on day-0 were predictive, while model for end-stage liver disease [area under the receiver operating characteristics (AUROC)-0.703, 95% confidence interval [CI]: 0.535-0.859] and Child-Turcotte-Pugh (AUROC-0.697, 95% CI: 0.550-0.855) on day-7 did. Conclusion: ACLF is a dynamic process; day-7 assessment with above predictors, to be considered a milestone for prognostication and opting treatment modalities. Serum ferritin does not predict early mortality in ACLF.

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Section: Discussionmentioning

confidence: 73%

Section: Discussionmentioning

confidence: 99%

Predictors of early mortality among patients with acute‐on‐chronic liver failure

Valantine

Sundaray

Mishra³

et al. 2021

JGH Open

View full text Add to dashboard Cite

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“…The goal of such therapy is to maintain MAP>65mm of hg. (82,83) The common resuscitation fluids used are crystalloids and 5% albumin (84) and the preferred vasopressors commonly used are norepinephrine, epinephrine, or terlipressin. IV fluids with balanced solutions improve renal function.…”

Section: Circulation Failure and Vasopressorsmentioning

confidence: 99%

Acute-on-chronic liver failure: Terminology, mechanisms and management

Br¹,

Sarin²

2023

Clin Mol Hepatol

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Acute on chronic liver failure (ACLF) is an acute deterioration of liver function manifesting as jaundice and coagulopathy with the development of ascites, with a high probability of extrahepatic organ involvement and high 28-day mortality. The pathogenesis involves extensive hepatic necrosis, which is associated with severe systemic inflammation and subsequently causes the cytokine storm, leading to portal hypertension, organ dysfunction, and organ failure. These patients have increased gut permeability, releasing lipopolysaccharide (LPS) and damage-associated molecular patterns (DAMPS) in the blood, leading to hyper-immune activation and the secretion of cytokines, followed by immune paralysis, causing the development of infections and organ failure in a proportion of patients. Early detection and the institution of treatment, especially in the "Golden Window" period of 7 days, give an opportunity for reversal of the syndrome. Scores like the APASL ACLF research consortium (AARC) score, a model for end stage liver disease (MELD), and the CLIF Consortium acute-on-chronic liver failure (CLIF C-ACLF) score can help in the prediction of mortality. Treatment strategy includes treatment of acute insult. Patients should be considered for early transplant with MELD score >28, AARC score >10, high-grade HE, and in the absence of > 2 organ failure or overt sepsis as there is a high chance of failure of conservative management and high mortality to improve survival of up to 80% at five years after liver transplantation.Patients, with no option of transplant, can be treated with emerging therapies like faecal microbial transplant, plasma exchange, etc., which need further evaluation.

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THU-040-AARC score: A dynamic model to predict outcome in acute on chronic liver failure patients

Cited by 2 publications

References 0 publications

Predictors of early mortality among patients with acute‐on‐chronic liver failure

Predictors of early mortality among patients with acute‐on‐chronic liver failure

Acute-on-chronic liver failure: Terminology, mechanisms and management

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