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J Hepatol. 2014 Nov;61(5):1038-47. doi: 10.1016/j.jhep.2014.06.012. Epub 2014 Jun 17.

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

Author information

1
Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, United Kingdom.
2
Hôpital Paul Brousse, Villejuif, France; Unité INSERM U785, Paris, France.
3
Data Management Centre of the EASL CLIF Consortium, Barcelona, Spain.
4
INSERM U773 and Service d'Hépatologie, Hôpital Beaujon, Clichy, France.
5
Hospital Clinic, Barcelona, Spain. Electronic address: PGINES@clinic.ub.es.
6
University of Padova, Italy.
7
Policlinico St Orsola Malpighi, Bologna, Italy.
8
Ludwig Maximilian University Munich, Klinikum der Universität München, Germany.
9
University of Turin, Italy.
10
Hospital Clinic, Barcelona, Spain.
11
King's College Hospital, London, UK.
12
University Hospital Gasthuisberg, Leuven, Belgium.
13
University Hospital Bonn, Germany.
14
J.W. Goethe University Hospital, Frankfurt, Germany.
15
Erasme Hospital Brussels, Belgium.
16
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
17
Hospital Vall d'Hebron, Barcelona, Spain.
18
Policlinico St Orsola Malpighi, Bologna, Italy; EASL-CLIF Consortium.
19
EASL-CLIF Consortium.

Abstract

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.

KEYWORDS:

Acute-on-chronic liver failure; Cirrhosis; Multi-organ failure; Prognosis; Sepsis

PMID:
24950482
DOI:
10.1016/j.jhep.2014.06.012
[Indexed for MEDLINE]
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