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Observational Study
. 2022 Nov 22;17(11):e0277959.
doi: 10.1371/journal.pone.0277959. eCollection 2022.

Validation of prognostic scores predicting mortality in acute liver decompensation or acute-on-chronic liver failure: A Thailand multicenter study

Tongluk Teerasarntipan  1 , Kessarin Thanapirom  1 , Sakkarin Chirapongsathorn  2 , Tanita Suttichaimongkol  3 , Naichaya Chamroonkul  4 , Chalermrat Bunchorntavakul  5 , Sith Siramolpiwat  6 , Siwaporn Chainuvati  7 , Abhasnee Sobhonslidsuk  8 , Apinya Leerapun  9 , Teerha Piratvisuth  4 , Wattana Sukeepaisarnjaroen  3 , Tawesak Tanwandee  7 , Sombat Treeprasertsuk  1
Affiliations
Observational Study

Validation of prognostic scores predicting mortality in acute liver decompensation or acute-on-chronic liver failure: A Thailand multicenter study

Tongluk Teerasarntipan et al. PLoS One. .

Abstract

Background & objectives: Cirrhosis patients with worsening of the liver function are defined as acute decompensation (AD) and those who develop extrahepatic organ failure are defined as acute-on-chronic liver failure (ACLF). Both AD and ACLF have an extremely poor prognosis. However, information regarding prognostic predictors is still lacking in Asian populations. We aimed to identify prognostic factors for 30-day and 90-day mortality in cirrhosis patients who develop AD with or without ACLF.

Methods: We included 9 tertiary hospitals from Thailand in a retrospective observational study enrolling hospitalized cirrhosis patients with AD. ACLF was diagnosed according to the EASL-CLIF criteria, which defined as AD patients who have kidney failure or a combination of at least two non-kidney organ failure. Outcomes were clinical parameters and prognostic scores associated with mortality evaluated at 30 days and 90 days.

Results: Between 2015 and 2020, 602 patients (301 for each group) were included. The 30-day and 90-day mortality rates of ACLF vs. AD were 57.48% vs. 25.50% (p<0.001) and 67.44% vs. 32.78% (p<0.001), respectively. For ACLF patients, logistic regression analysis adjusted for demographic data, and clinical information showed that increasing creatinine was a predictor for 30-day mortality (p = 0.038), while the CLIF-C OF score predicted both 30-day (p = 0.018) and 90-day (p = 0.037) mortalities, achieving the best discriminatory power with AUROCs of 0.705 and 0.709, respectively. For AD patients, none of the parameters was found to be significantly associated with 30-day mortality, while bacterial infection, CLIF-AD score and Child-Turcotte-Pugh score were independent parameters associated with 90-day mortality, with p values of 0.041, 0.024 and 0.024. However, their predictive performance became nonsignificant after adjustment by multivariate regression analysis.

Conclusions: Regarding Thai patients, the CLIF-C OF score was the best predictor for 30-day and 90-day mortalities in ACLF patients, while appropriate prognostic factors for AD patients remained inconclusive.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Fig 1
Fig 1. Comparison of short-term mortality rates based on liver decompensation severity.
Fig 2
Fig 2. Survival based on liver decompensation severity.
By overall, log rank tests showed survival difference between groups, p<0.001. Log rank test results between AD vs. ACLF groups, ACLF grade 1 vs. ACLF grade 2, and ACLF grade 2 vs. ACLF grade 3 were p<0.001, p = 0.002*, and p<0.001**, respectively.
Fig 3
Fig 3. Diagnostic performance of each prognostic score in predicting short-term mortality in ACLF patients.
a. 1-Month mortality prediction value. b. 3-Month mortality prediction value.
See this image and copyright information in PMC

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