Abstract
Patients with liver cirrhosis have a higher risk of developing acute-on-chronic liver failure (ACLF). Poor prognosis with a high rate of short-term mortality leads to limited opportunities for further liver transplantation. Thus, precise prognostic evaluation of patients with ACLF is necessary before transplant surgery. In this study, a total of one hundred and thirty-five patients with ACLF admitted to the hepato-gastroenterologic intensive care unit (ICU) for intensive monitoring and treatment at Chang-Gung Memorial Hospital (CGMH, Linkou, Taiwan) were screened from November 2012 to April 2015 and tracked until April 2017. Three new prognostic scores of ACLF, including CLIF-C ACLF (Chronic Liver Failure Consortium Acute-on-chronic Liver Failure score), CLIF-C ACLF-D (CLIF-C ACLF Development score), and CLLF-C ACLFlactate (lactate-adjusted CLIF-C ACLF score) were compared. The primary outcome considered was overall mortality. Mortality predictions at 28, 90, 180, and 365 days were also calculated. By area under the receiver operating characteristic curve (AUROC) analysis, the CLIF-C ACLF and CLIF-C ACLF-D scores were superior to CLIF-C ACLFlactate scores in predicting 28-day mortality. The CLIF-C ACLF-D score had the highest AUROC in predicting overall mortality as well as at 90, 180, and 365 days. In conclusion, our study demonstrates that CLIF-C ACLF and CLIF-C ACLF-D scores are significant predictors of outcome in critical patients with liver cirrhosis and ACLF. The CLIF-C ACLF-D score may have a superior predictive power for the prediction of 3-month, 6-month, and one-year mortality.
Highlights
Patients with liver cirrhosis are more inclined to suffer acute decompensation complicated with organ failure, which is defined as having acute-on-chronic liver failure (ACLF) [1]
The up-to-date CLIF-C ACLF-D score was developed in the PREDICT (PREDICTing Acute-on-Chronic Liver Failure) study [11], which investigated the pathophysiological mechanisms of acute decompensation in liver cirrhosis
From November 2012 to April 2015, a total of one hundred and thirty-five ACLF patients hospitalized to the hepato-gastroenterologic intensive care unit (ICU) were recruited after evaluating the inclusion and exclusion criteria (Figure 1) and were tracked until April 2017
Summary
Patients with liver cirrhosis are more inclined to suffer acute decompensation complicated with organ failure, which is defined as having acute-on-chronic liver failure (ACLF) [1]. The syndrome usually requires admission to an intensive care unit (ICU) due to high mortality. The up-to-date CLIF-C ACLF-D score was developed in the PREDICT (PREDICTing Acute-on-Chronic Liver Failure) study [11], which investigated the pathophysiological mechanisms of acute decompensation in liver cirrhosis. This new score was developed to predict the probability of a patient with AD developing ACLF within 3 months of hospital admission and showed a similar accuracy but smaller difference than other scores in the validation set [10]
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