Comparison of CLIF-C ACLF Score and MELD Score in Predicting ICU Mortality in Patients with Acute-On-Chronic Liver Failure.

Abstract

IntroductionAcute-on-chronic liver failure (ACLF) is a serious complication of liver cirrhosis which presents with hepatic and/or extrahepatic organ failure and often needs admission to an Intensive Care Unit (ICU). This condition typically needs organ support and carries a high mortality rate. ICU care may not benefit these patients. There are many scores to assess prognosis in these patients, such as the Model for End-stage Liver Disease (MELD) score, the MELD score refined to take into account serum sodium level (MELD-Na), the chronic liver failure organ failure (CLIF-OF) score, the CLIF Consortium acute-on-chronic liver failure (CLIF-C ACLF) score and the Child-Turcotte-Pugh classification. This study was conducted to compare CLIF-C ACLF and MELD scores for selecting patients at risk of high mortality, as ICU care to these patients in the absence of liver transplantation may be of no value.MethodsThe data of 75 patients admitted to the ICU of Shifa International Hospital in Islamabad were prospectively analyzed. CLIF-C ACLF and MELD scores were calculated at admission and then at 24 and 48 hours after the ICU stay. Data were analyzed with the assistance of SPSS. Mortality was the primary outcome.ResultsComparison of both scores showed that a CLIF-C ACLF score ≥ 70 at 48 hours predicts mortality more accurately, with an area under receiver operating curve (AUROC) of 0.643 (confidence interval [CI] 95% 0.505-0.781; p=0.046) which was significantly higher than MELD scores of 30,40 and 50 at 48 hours. Organ failure and the need for supportive care were strong predictors of mortality (p= < 0.05).ConclusionWe concluded that a CLIF-C ACLF score ≥ 70 at 48 hours and organ failure are better predictors of mortality and that ICU care in these patients does not benefit them. Definitive therapy in the form of liver transplantation may have a promising role, if considered early.