EASIX Is an Accurate and Easily Available Prognostic Score in Critically Ill Patients with Advanced Liver Disease

Abstract

Acute-on-chronic liver failure (ACLF) is associated with high mortality. Objective prognostic scores are important for treatment decisions. EASIX (Endothelial Activation and Stress Index) is a simple biomarker consisting of LDH, platelets, and creatinine, reflecting endothelial dysfunction after allogeneic stem cell transplantation. Considering endothelial dysfunction in the pathogenesis of ACLF, this study aimed to test the discriminative ability of EASIX in advanced liver disease. We retrospectively analysed the prognostic potential of EASIX to predict 28-day and 3-month mortality in a total of 188 liver cirrhotic patients requiring treatment at the intensive care unit. We evaluated the ability of EASIX to rule out early infections and predict the need for hemodialysis. EASIX performed moderately better than established scores in predicting 28-day mortality (AUC = 0.771) and was nearly equivalent (AUC = 0.791) to SOFA and APACHE-II in the prediction of 3-month mortality. Importantly, EASIX showed better diagnostic potential in ruling out clinically apparent infections than common proinflammatory markers (AUC = 0.861, p < 0.001) and showed suitable accuracy in predicting the need for hemodialysis (AUC = 0.833). EASIX is an accurate, objective and easily assessable biomarker for predicting mortality and complications in patients with advanced liver disease.

Keywords: EASIX; acute-on-chronic liver failure; endothelial dysfunction; intensive care unit; liver cirrhosis.

Figure 1

Prognostic accuracy of EASIX versus clinical scores to predict mortality in patients with advanced liver disease (N = 188): (A) 28-day mortality; and (B) 3-month mortality.

Figure 2

Prognostic ability of EASIX in ACLF-patients (N = 165) versus CLIF-OF and CLIF-ACLF to predict mortality: (A) 28-day mortality; and (B) 3-month mortality.

Figure 3

Survival analyses based on EASIX on admission to the ICU. (A) Total study population of 188 patients (baseline levels of EASIX ≤ 7.1 versus > 7.1); and (B) subgroup of 165 patients fulfilling ACLF criteria (admission levels of EASIX ≤ 7.1 versus > 7.1). *** = p < 0.001.

Figure 4

Diagnostic ability of baseline EASIX. (A) Diagnostic ability of baseline EASIX to rule out clinically overt infections (“No Infection”) on ICU admission in comparison with PCT, CRP and WBC. (B) Predictive value of baseline EASIX compared with common clinical scores in identifying patients requiring hemodialysis therapy during their ICU stay.