Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure.


BACKGROUND & AIMS Acute-on-chronic liver failure (ACLF) is a frequent syndrome (30% prevalence), characterized by acute decompensation of cirrhosis, organ failure(s) and high short-term mortality. This study develops and validates a specific prognostic score for ACLF patients. METHODS Data from 1349 patients included in the CANONIC study were used. First, a simplified organ function scoring system (CLIF Consortium Organ Failure score, CLIF-C OFs) was developed to diagnose ACLF using data from all patients. Subsequently, in 275 patients with ACLF, CLIF-C OFs and two other independent predictors of mortality (age and white blood cell count) were combined to develop a specific prognostic score for ACLF (CLIF Consortium ACLF score [CLIF-C ACLFs]). A concordance index (C-index) was used to compare the discrimination abilities of CLIF-C ACLF, MELD, MELD-sodium (MELD-Na), and Child-Pugh (CPs) scores. The CLIF-C ACLFs was validated in an external cohort and assessed for sequential use. RESULTS The CLIF-C ACLFs showed a significantly higher predictive accuracy than MELDs, MELD-Nas, and CPs, reducing (19-28%) the corresponding prediction error rates at all main time points after ACLF diagnosis (28, 90, 180, and 365 days) in both the CANONIC and the external validation cohort. CLIF-C ACLFs computed at 48 h, 3-7 days, and 8-15 days after ACLF diagnosis predicted the 28-day mortality significantly better than at diagnosis. CONCLUSIONS The CLIF-C ACLFs at ACLF diagnosis is superior to the MELDs and MELD-Nas in predicting mortality. The CLIF-C ACLFs is a clinically relevant, validated scoring system that can be used sequentially to stratify the risk of mortality in ACLF patients.

DOI: 10.1016/j.jhep.2014.06.012

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@article{Jalan2014DevelopmentAV, title={Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure.}, author={Rajiv Jalan and Faouzi Saliba and Marco Pavesi and {\`A}lex Amor{\'o}s and Richard Moreau and Pere Gin{\'e}s and Eric Levesque and François Durand and Paolo Angeli and Paolo Caraceni and Corinna Hopf and Carlo Alessandria and Ezequiel Garcia - Rodriguez and Pablo A Sol{\'i}s-Mu{\~n}oz and Wim Laleman and Jonel Trebicka and Stefan Zeuzem and Thierry Gustot and Rajeshwar P Mookerjee and Laure Elkrief and Germ{\'a}n Soriano and Joan C{\'o}rdoba and Filippo Morando and Alexander L Gerbes and Banwari Agarwal and Didier Samuel and Mauro Bernardi and Vicente Arroyo}, journal={Journal of hepatology}, year={2014}, volume={61 5}, pages={1038-47} }