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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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
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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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cited_by cdi_FETCH-LOGICAL-c525t-29439e8942dfe0a48a1d79d25f6aef01d835a29037398fe526b4ca676a9058213
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container_end_page 1047
container_issue 5
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container_title Journal of hepatology
container_volume 61
creator 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
description 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_str_mv 10.1016/j.jhep.2014.06.012
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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.</description><identifier>ISSN: 0168-8278</identifier><identifier>EISSN: 1600-0641</identifier><identifier>DOI: 10.1016/j.jhep.2014.06.012</identifier><identifier>PMID: 24950482</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>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</subject><ispartof>Journal of hepatology, 2014-11, Vol.61 (5), p.1038-1047</ispartof><rights>European Association for the Study of the Liver</rights><rights>2014 European Association for the Study of the Liver</rights><rights>Copyright © 2014 European Association for the Study of the Liver. 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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. 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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.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>24950482</pmid><doi>10.1016/j.jhep.2014.06.012</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record>
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identifier ISSN: 0168-8278
ispartof Journal of hepatology, 2014-11, Vol.61 (5), p.1038-1047
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1600-0641
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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
title Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure
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