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16 May 2020 : Clinical Research  

Acute-On-Chronic Liver Failure: The Role of Prognostic Scores in a Single-Center Experience

Grzegorz Niewiński1ABCDEFG, Szymon Morawiec1BCDEF, Maciej K. Janik2BCDEF, Michał Grąt3ABCDEFG, Agata Graczyńska1BCDEF, Krzysztof Zieniewicz3ABCDEFG, Joanna Raszeja-Wyszomirska2ABCDEFG*

DOI: 10.12659/MSM.922121

Med Sci Monit 2020; 26:e922121

Abstract

BACKGROUND: Acute-on-chronic liver failure (ACLF) is associated with multi-organ failure and high short-term mortality. We evaluated the role of currently available prognostic scores for prediction of 90-day mortality in ACLF patients.

MATERIAL AND METHODS: Fifty-five (M/F=40/15, mean age 60.0±11.1years) consecutive cirrhotic patients with severe liver insufficiency (mean MELD 28.4±9.0, Child-Pugh score – C-12) were enrolled into the study. MELD variants and SOFA, CLIF-SOFA, and CLIF-C scores were calculated, mortality predicting factors were identified, and clinical comparisons between ACLF and AD patients were performed.

RESULTS: In total, 30 (55%) patients were transplanted (22 ACLF and 8 AD), and 20 (30%) died (19 ACLF and 1 AD). Five (9%) patients survived without liver transplantation (LT) (3 ACLF and 2 AD), and 3 transplant recipients died within 1 month. SOFA, CLIF-SOFA, CLIF-C OF, and INR were significantly associated with the incidence of 90-day mortality in competing risk regression analysis (all p<0.001). The model based on SOFA had the lowest BIC, with the optimal cut-off for 90-day mortality prediction ≥12, with the area under the receiver operating characteristic (AUROC) of 0.901 (95% CI 0.779–1.000; p<0.001), and corresponding incidence of transplantation rates of 85.5% and 11.8%, respectively (p<0.001). Of note, the important role of 24-h urine output is emphasized.

CONCLUSIONS: In this series of ACLF patients, SOFA score outperformed the CLIF-C scores in predicting 90-day mortality. Multi-organ failure scores performed better in predicting patient mortality than conventional liver function assessment. LT is possible and remains effective in selected ACLF patients.

Keywords: Liver Failure, Acute, Organ Dysfunction Scores, Transplantation, Homologous, Acute-On-Chronic Liver Failure, Aged, Area Under Curve, Middle Aged, Prognosis, ROC Curve, Risk Assessment, Severity of Illness Index, Time Factors

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Ana Luisa Ordóñez-Vázquez, Sofía Murúa Beltrán-Gall, Shreya C. Pal, Nahum Méndez-Sánchez
Liver Research Unit, Medica Sur Clinic Foundation, Mexico City, Mexico

DOI: 10.12659/MSM.938365

Med Sci Monit 2022; 28:e938365

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Medical Science Monitor eISSN: 1643-3750
Medical Science Monitor eISSN: 1643-3750