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. 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

Rajiv Jalan  1 , Faouzi Saliba  2 , Marco Pavesi  3 , Alex Amoros  3 , Richard Moreau  4 , Pere Ginès  5 , Eric Levesque  2 , Francois Durand  4 , Paolo Angeli  6 , Paolo Caraceni  7 , Corinna Hopf  8 , Carlo Alessandria  9 , Ezequiel Rodriguez  10 , Pablo Solis-Muñoz  11 , Wim Laleman  12 , Jonel Trebicka  13 , Stefan Zeuzem  14 , Thierry Gustot  15 , Rajeshwar Mookerjee  1 , Laure Elkrief  4 , German Soriano  16 , Joan Cordoba  17 , Filippo Morando  7 , Alexander Gerbes  8 , Banwari Agarwal  1 , Didier Samuel  2 , Mauro Bernardi  18 , Vicente Arroyo  19 ; CANONIC study investigators of the EASL-CLIF Consortium
Collaborators, Affiliations

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

Rajiv Jalan et al. J Hepatol. 2014 Nov.

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.

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