Validation of prognostic scores predicting mortality in acute liver decompensation or acute-on-chronic liver failure: A Thailand multicenter study

Teerasarntipan, Tongluk; Thanapirom, Kessarin; Chirapongsathorn, Sakkarin; Suttichaimongkol, Tanita; Chamroonkul, Naichaya; Bunchorntavakul, Chalermrat; Siramolpiwat, Sith; Chainuvati, Siwaporn; Sobhonslidsuk, Abhasnee; Leerapun, Apinya; Piratvisuth, Teerha; Sukeepaisarnjaroen, Wattana; Tanwandee, Tawesak; Treeprasertsuk, Sombat

doi:10.1371/journal.pone.0277959

Cited by 4 publications

(3 citation statements)

References 41 publications

(58 reference statements)

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“…The predictive ability of CLIF-C ACLFs is relatively low in predicting short-and long-term mortality in ACLF patients with a concomitant need for ICU treatment (24)(25)(26). However, the MELD score is the most predictive score (27). Our results con rm the ability of both scores in predicting ACLF development in these patients.…”

Section: Discussionsupporting

confidence: 77%

Predictors of acute-on-chronic liver failure (ACLF) and mortality in ambulatory cirrhotic patients

Basheer,

Asaad,

Boulos

et al. 2024

Preprint

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Background Acute-on-chronic liver failure (ACLF) is life-threatening complication of cirrhosis. ACLF’s prevalence and outcomes have been described in hospitalized patients with cirrhosis. However, no data is available on the prevalence and predictors of ACLF in ambulatory cirrhotic patients. Aims Assessment of the incidence and predictors of ACLF in cirrhotic ambulatory patients. Methods A retrospective study of 202 ambulatory patients with cirrhosis was evaluated in a tertiary hospital at the Galilee Medical Center from Feb. 2015 to Dec. 2022 and followed for eight years. Data on developing hepatic and extrahepatic organ failures were collected. ACLF was defined and graded according to the European Association for the Study of Liver-Chronic Liver Failure (EASL-CLIF) Consortium definition. Results Ambulatory with cirrhosis developed ACLF in 37% of cases (74 patients). The mortality rate was significantly high in the ACLF group as compared to the non-ACLF group (38% VS 8.5%, respectively P < 0.001). Patients with ACLF were older, had increased CRP, NLR and WBC, increased LFTS and kidney function, MELD, Child-Pugh, CLIF-C and PADUA scores. Univariate regression showed that MELD score was the most powerful predictor of organ failure. Multivariate analysis showed that MELD and CLIF-C scores were associated with organ failure and developing ACLF (OR 4.5, P < 0.001, OR 3.2, P < 0.001, respectively). Discriminant analysis showed that BUN, MELD, CLIF-C and PADUA scores predicted mortality with 87% accuracy. Conclusion Outpatients with cirrhosis developed ACLF in 40% of cases. MELD and CLIF-C scores are the best ACLF development predictors. PADUA, CLIF-C and MELD scores are the best predictors of mortality. Therefore, we should use MELD, PADUA and CLIF-C scores to evaluate and follow up cirrhotic outpatients in liver units.

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Section: Discussionsupporting

confidence: 77%

Predictors of acute-on-chronic liver failure (ACLF) and mortality in ambulatory cirrhotic patients

Basheer,

Asaad,

Boulos

et al. 2024

Preprint

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“…In contrast, the CLIF-C OFs and the CLIF-C ACLFs performed worse in our study. A retrospective study from Thailand with over 600 patients with acute decompensation of liver cirrhosis was able to provide similar data [ 16 ]. Here, the CLIF-OF score also showed only a moderate predictive value in relation to the 30- and 90-day mortality.…”

Section: Discussionmentioning

confidence: 98%

Validation of the CLIF-C OF Score and CLIF-C ACLF Score to Predict Transplant-Free Survival in Patients with Liver Cirrhosis and Concomitant Need for Intensive Care Unit Treatment

et al. 2023

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Both the Chronic Liver Failure Consortium (CLIF-C) organ failure score (OFs) and the CLIF-C acute-on-chronic-liver failure (ACLF) score (ACLFs) were developed for risk stratification and to predict mortality in patients with liver cirrhosis and ACLF. However, studies validating the predictive ability of both scores in patients with liver cirrhosis and concomitant need for intensive care unit (ICU) treatment are scarce. The aim of the present study is to validate the predictive ability of the CLIF-C OFs and CLIF-C ACLFs regarding the rationale of ongoing ICU treatment and to investigate their predictive ability regarding 28-days (short-), 90-days (medium-), and 365-days (long-term) mortality in patients with liver cirrhosis treated in an ICU. Patients with liver cirrhosis and acute decompensation (AD) or ACLF and concomitant need for ICU treatment were retrospectively analyzed. Predictive factors for mortality, defined as transplant-free survival, were identified using multivariable regression analyses and the predictive ability of CLIF-C OFs, CLIF-C ACLFs, MELD score, and AD score (ADs) was assessed by determining the AUROC. Of 136 included patients, 19 patients presented with AD and 117 patients with ACLF at ICU admission. In multivariable regression analyses, CLIF-C OFs as well as CLIF-C ACLFs were independently associated with higher short-, medium-, and long-term mortality after adjusting for confounding variables. The predictive ability of the CLIF-C OFs in the total cohort in short-term was 0.687 (95% CI 0.599–0.774). In the subgroup of patients with ACLF, the respective AUROCs were 0.652 (95% CI 0.554–0.750) and 0.717 (95% CI 0.626–0.809) for the CLIF-C OFs and for the CLIF-C ACLFs, respectively. ADs performed well in the subgroup of patients without ACLF at ICU admission with an AUROC of 0.792 (95% CI 0.560–1.000). In the long-term, the AUROCs were 0.689 (95% Cl 0.581–0.796) and 0.675 (95% Cl 0.550–0.800) for CLIF-C OFs and CLIF-C ACLFs, respectively. The predictive ability of CLIF-C OFs and CLIF-C ACLFs was relatively low to predict short- and long-term mortality in patients with ACLF with concomitant need for ICU treatment. However, the CLIF-C ACLFs may have special merit in judging futility of further ICU treatment.

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“…However, in keeping with the EASL/American Association for the Study of Liver Diseases (AASLD) criteria, none of the three scores including MELD, Child–Pugh, and albumin-bilirubin (ALBI) were considerably related to the in-hospital mortality [ 34 ]. Another study found that compared with other scores, CLIF-C ACLFs had the highest AUROC in predicting 28-day mortality [ 35 ], while other studies reported that the predictive accuracy of CLIF-SOFAs and the simpler CLIF-C OFs for mortality were considerably higher than that of CLIF-C ACLFs and MELDs [ 36 , 37 ]. The CLIF-C OFs is a model that quantifies severity of organ dysfunction and calculates the sum to estimate the prognosis of ACLF.…”

Section: Discussionmentioning

confidence: 99%

Plasma S100A8 and S100A9 Are Strong Prognostic Factors for Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

Zhang,

Han

et al. 2023

Canadian Journal of Gastroenterology and Hepatology

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Objectives. The rapidly evolving organ failure and high short-run mortality of acute-on-chronic liver failure (ACLF) are inseparable from the role of systemic inflammatory response. S100A8 and S100A9 are associated with the excessive cytokine storm and play a decisive part within the process of inflammation. We aimed to clarify the role of them in predicting prognosis of hepatitis B virus-related ACLF (HBV-ACLF). Methods. S100A8 and S100A9 levels were analyzed in plasma of 187 transplant-free HBV-ACLF patients, 28 healthy controls and 40 chronic hepatitis B (CHB) patients. S100A8 and S100A9 mRNAs were checked in liver samples from 32 HBV-ACLF patients with liver transplantation, 19 patients undergoing surgery for hepatic hemangioma and 10 CHB patients with needle biopsy. Results. The plasma levels of the S100A8 and S100A9 were higher in HBV-ACLF patients than in CHB patients (S100A8 : P < 0.001 and S100A9 : P < 0.001 ) and healthy controls (S100A8 : P < 0.001 and S100A9 : P < 0.001 ), and similar results were obtained for mRNA expression. Moreover, both proteins were related to ACLF grade, different types of organ failure, and infection, and they correlated with other prognostic scoring systems. S100A8 and S100A9 can dependently predict 28/90-day mortality (28-day: S100A8: hazard ratio (HR): 1.027; 95% confidence interval (CI): 1.007–1.048; P = 0.026 , S100A9 : HR: 1.009; 95% CI: 1.001–1.017; P = 0.007 , 90-day: S100A8 : HR: 1.023; 95% CI: 1.011–1.035; P = 0.004 , S100A9 : HR: 1.008; 95% CI: 1.004–1.012; and P < 0.001 ). Among all of the scoring systems, the combined scoring model (S100A8 and S100A9 jointly with the Chronic Liver Failure-Consortium Organ Failure score (CLIF-C OFs)) displayed the highest area under the receiver operating curve (0.923 (95% CI, 0.887–0.961)) in the prediction of 90-day mortality. Conclusions. S100A8 and S100A9 are promising biomarkers for the analysis of risk stratification and prognosis in ACLF patients. In addition, combining them with the CLIF-C OFs may better predict the prognosis of ACLF.

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Validation of prognostic scores predicting mortality in acute liver decompensation or acute-on-chronic liver failure: A Thailand multicenter study

Cited by 4 publications

References 41 publications

Predictors of acute-on-chronic liver failure (ACLF) and mortality in ambulatory cirrhotic patients

Predictors of acute-on-chronic liver failure (ACLF) and mortality in ambulatory cirrhotic patients

Validation of the CLIF-C OF Score and CLIF-C ACLF Score to Predict Transplant-Free Survival in Patients with Liver Cirrhosis and Concomitant Need for Intensive Care Unit Treatment

Plasma S100A8 and S100A9 Are Strong Prognostic Factors for Hepatitis B Virus-Related Acute-on-Chronic Liver Failure

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