Utility of prognostic scores in predicting short-term mortality in patients with acute-on-chronic liver failure

Abstract

Background Acute-on-chronic liver failure (ACLF) is a distinct syndrome associated with high short-term mortality. Early identification of patients at high risk is essential to determine emergency for transplantation and decide and prioritize the need for intensive care unit (ICU). We aimed to evaluate the performance of the different prognostic scores in the prediction of in-hospital mortality in patients with ACLF. A total of 249 patients with ACLF were included and followed till discharge from the hospital. Univariate and Cox regression analyses were used to assess the performance of liver-specific (Child-Pugh and MELD) and ACLF prognostic scores (CLIF-C OF, CLIF-SOFA, CLIF-C AD, CLIF-C ACLF) in the prediction of in-hospital mortality. Results Patients were mostly males (71.1%) with a mean age of 53.9 ± 12.8 years. The etiology of pre-existing liver disease was HCV in 57.8%. Sepsis was the most common precipitating factor (49.8%) and the mortality rate was 74.3%. In univariate analysis, all scores were significantly higher in the deceased group (P<0.0001). AUROC were 0.897, 0.884, 0.870, 0.861, 0.861, and 0.850 for CLIF-C OF, CLIF-C AD, CLIF-C ACLF, Child-Pugh, CLIF-SOFA, and MELD scores, respectively. In multivariate analysis, 2 independent predictors of mortality were identified: CLIF-C ACLF score (OR 3.25, 95% CI 1.03–10.25, P<0.0001) and Child-Pugh class C (OR 1.04, 95% CI 1.02–1.06, P=0.044). Conclusions All the studied scores could predict in-hospital mortality of patients with ACLF. However, CLIF-C ACLF and Child-Pugh class performed better as they could significantly and independently predict mortality.

Assessment of the Predictors and Mortality in Patients of Acute on Chronic Liver Failure; A Prospective Study

“…Early detection of the cases at high risk is crucial to determining whether they require an ICU and the need of organ transplantation. 3 In this study a total of 99 cases of ACLF were studies to assess the predictors and mortality in patients of Acute-On-Chronic Liver Failure (ACLF). In this study the men age of the patients was 40.90+13.93 years and males were in majority (73.5%).…”

“…These differences in the mortality rates could be explained by differences in the definition of ACLF and recommendations employed in these various settings, the diversity of patient characteristics and ethnic backgrounds, and the relative variability in the reversibility of the intense predisposing insult in addition to the grades of the ACLF. 3 An improper inflammatory response and immune system dysfunction that makes people more susceptible to infections are likely the causes of the increased mortality rate linked to ACLF. 11 In this study hepatic failure, renal failure, CNS failure, coagulation failure and grading of ACLF were significantly associated to short term survival rate (p= <0.05).…”

“…encephalopathy, ascites, and bacterial infection), as well as single or even more extrahepatic organ impairments, and it has a high short-term (28 days) mortality rate of 33% and at 90 days, 51% mortality. 3,4 In the vast majority of cases, ACLF caused the acute incident that adds an inflammatory surge to the baseline chronic inflammation prevalent in those who have cirrhosis of the liver and the decompensation. Failure of the organ is caused by a number of processes, which include an increase in inflammatory mediators and organ hypoperfusion.…”

“…Furthermore, approximately 40% of people with ACLF had no apparent acute incident prior to the onset of ACLF. 3,4 Regardless of the absence of prospective data to characterize this, there has been a substantial amount of credible evidence that this ailment is a unique clinical phenomenon. 6 From such a pathophysiologic standpoint, alterations in the host's reaction to injuries and infection are crucial towards its progression.…”

Characteristics and predictors of short-term mortality in decompensated cirrhotic patients with acute-on-chronic liver failure

“…In up to half of cases, ACLF can improve or even completely resolve, but in the other half, disease progression may result in a life-threatening condition [5]. Early identification of predictors of short-term mortality in ACLF is crucial due to the high mortality rate, to identify patients at risk who will require intensive care management, specific treatments, or emergency liver transplantation [6].…”