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. 2021 Jan 29;11(2):79.
doi: 10.3390/jpm11020079.

Comparing CLIF-C ACLF, CLIF-C ACLFlactate, and CLIF-C ACLF-D Prognostic Scores in Acute-on-Chronic Liver Failure Patients by a Single-Center ICU Experience

Chao-Cheng Kuo  1 , Chien-Hao Huang  1   2 , Ching Chang  1 , Pin-Cheng Chen  1 , Bo-Huan Chen  1 , Wei-Ting Chen  1   2 , Yu-Pin Ho  1   2
Affiliations

Comparing CLIF-C ACLF, CLIF-C ACLFlactate, and CLIF-C ACLF-D Prognostic Scores in Acute-on-Chronic Liver Failure Patients by a Single-Center ICU Experience

Chao-Cheng Kuo et al. J Pers Med. .

Abstract

Patients with liver cirrhosis have a higher risk of developing acute-on-chronic liver failure (ACLF). Poor prognosis with a high rate of short-term mortality leads to limited opportunities for further liver transplantation. Thus, precise prognostic evaluation of patients with ACLF is necessary before transplant surgery. In this study, a total of one hundred and thirty-five patients with ACLF admitted to the hepato-gastroenterologic intensive care unit (ICU) for intensive monitoring and treatment at Chang-Gung Memorial Hospital (CGMH, Linkou, Taiwan) were screened from November 2012 to April 2015 and tracked until April 2017. Three new prognostic scores of ACLF, including CLIF-C ACLF (Chronic Liver Failure Consortium Acute-on-chronic Liver Failure score), CLIF-C ACLF-D (CLIF-C ACLF Development score), and CLLF-C ACLFlactate (lactate-adjusted CLIF-C ACLF score) were compared. The primary outcome considered was overall mortality. Mortality predictions at 28, 90, 180, and 365 days were also calculated. By area under the receiver operating characteristic curve (AUROC) analysis, the CLIF-C ACLF and CLIF-C ACLF-D scores were superior to CLIF-C ACLFlactate scores in predicting 28-day mortality. The CLIF-C ACLF-D score had the highest AUROC in predicting overall mortality as well as at 90, 180, and 365 days. In conclusion, our study demonstrates that CLIF-C ACLF and CLIF-C ACLF-D scores are significant predictors of outcome in critical patients with liver cirrhosis and ACLF. The CLIF-C ACLF-D score may have a superior predictive power for the prediction of 3-month, 6-month, and one-year mortality.

Keywords: CLIF-C ACLF; CLIF-C ACLF-D; acute-on-chronic liver failure (ACLF); area under the ROC curve (AUROC); error bars; intensive care unit; lactate-adjusted CLIF-C ACLFs (CLIF-C ACLFlactate score); liver cirrhosis.

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Conflict of interest statement

The authors declare no conflict of interest. The funders had no role in the design of the study; in the collection, analyses, or interpretation of data; in the writing of the manuscript; or in the decision to publish the results.

Figures

Figure 1
Figure 1
Flow chart demonstrating the process for patient recruitment, inclusion, and exclusion of ACLF cases in the intensive care unit.
Figure 2
Figure 2
Error bar analysis with confidence intervals at 28-day (a), 90-day (b), 180-day (c), and 365-day (d) follow-up for each score compared between survivors and non-survivors.
Figure 3
Figure 3
Comparison of the three prognostic scores predicting overall survival (a) and 28-day (b), 90-day (c), 180-day (d), and 365-day (e) mortality by AUROC analysis.
See this image and copyright information in PMC

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