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...

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Bibliographic Details
Published in:Journal of hepatology 2014-11, Vol.61 (5), p.1038-1047
Main Authors: Jalan, Rajiv, Saliba, Faouzi, Pavesi, Marco, Amoros, Alex, Moreau, Richard, Ginès, Pere, Levesque, Eric, Durand, Francois, Angeli, Paolo, Caraceni, Paolo, Hopf, Corinna, Alessandria, Carlo, Rodriguez, Ezequiel, Solis-Muñoz, Pablo, Laleman, Wim, Trebicka, Jonel, Zeuzem, Stefan, Gustot, Thierry, Mookerjee, Rajeshwar, Elkrief, Laure, Soriano, German, Cordoba, Joan, Morando, Filippo, Gerbes, Alexander, Agarwal, Banwari, Samuel, Didier, Bernardi, Mauro, Arroyo, Vicente
Format: Article
Language:English
Subjects:
Acute-on-chronic liver failure
Acute-On-Chronic Liver Failure - diagnosis
Acute-On-Chronic Liver Failure - mortality
Adult
Aged
Cirrhosis
Cohort Studies
Databases, Factual
Europe - epidemiology
Female
Gastroenterology and Hepatology
Humans
Liver Cirrhosis - mortality
Male
Middle Aged
Multi-organ failure
Prognosis
Sepsis
Severity of Illness Index
Time Factors
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Summary: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.
ISSN:0168-8278
1600-0641
DOI:10.1016/j.jhep.2014.06.012