Alcohol-related acute-on-chronic liver failure—Comparison of various prognostic scores in predicting outcome
Background and Aims
Various prognostic scores are available for predicting outcome in acute-on-chronic liver failure (ACLF). We compared the available prognostic models as predictors of outcome in alcohol-related ACLF patients.
All consecutive patients with alcohol-related ACLF were included. At admission, prognostic indices-acute physiology and chronic health evaluation score (APACHE II), model for end-stage liver disease (MELD), MELD-Na, Maddrey’s discriminant function (DF), age-bilirubin-INR-creatinine (ABIC), and Chronic Liver Failure Consortium (CLIF-C) ACLF score (CLIF-C ACLF) score were calculated. Receiver operator characteristic (ROC) curves were plotted for all prognostic scores with in-hospital, 90-day, and 1-year mortality as outcome.
Of the 171 patients, 170 were males, and grade 1 ACLF in 20 (11.7%), grade 2 in 52 (30.4%), and grade 3 in 99 (57.9%) patients. One hundred and nineteen (69.6%) died in-hospital. The median (IQR) Maddrey’s score, MELD, MELD-Na, ABIC, APACHE II, and CLIF-C ACLF were 87.8 (66.5–123.0), 33.1 (27.6–40.0), 34.4 (29.5–40.0), 8.5 (7.3–9.6), 15 (12–21), and 51.1 (44.1–56.4), respectively. On multivariate Cox regression analysis, independent predictors of in-hospital outcome were presence of hepatic encephalopathy (early HR, 2.078; 95%CI, 1.173–3.682, p = 0.012 and advanced, HR, 2.330; 95% CI, 1.270–4.276, p = 0.006), elevated serum creatinine (HR, 1.140; 95% CI, 1.023–1.270, p = 0.018), and infection at admission (HR, 1.874; 95% CI, 1.160–23.029, p = 0.010). On comparison of ROC curves, APACHE II and CLIF-C ACLF AUROC were significantly higher than MELD, MELD-Na, DF, and ABIC (p < 0.05) for predicting in-hospital, 90-day, and 1-year mortality. The AUROC was highest for APACHE II followed by CLIF-C ACLF (Hanley and McNeil, p = 0.660).
Alcohol-related ACLF has high in-hospital mortality. Among the available prognostic scores, CLIF-C ACLF and APACHE II perform best.
KeywordsAcute-on-chronic liver failure Mortality APACHE II score CLIF-C ACLF score Prognostic score
Ujjwal Sonika: acquisition of data, data analysis, interpretation of data, and drafting of manuscript.
Shekhar Jadaun: acquisition of data and drafting of manuscript.
Gyan Ranjan: acquisition of data and drafting of manuscript.
Gyanranjan Rout: acquisition of data and drafting of manuscript.
Deepak Gunjan: acquisition of data and drafting of manuscript.
Saurabh Kedia: acquisition of data and drafting of manuscript.
Baibaswata Nayak: acquisition of data and drafting of manuscript.
Shalimar: study design and concept, interpretation of data, and critical revision of manuscript for important intellectual content
Compliance with ethical standards
Conflict of interest
US, SJ, GR, GR, DG, SK, BN, and S declare that they have no conflict of interest.
The authors declare that the study was performed in a manner to conform to the Helsinki Declaration of 1975, as revised in 2000 and 2008, concerning human and animal rights. The protocol was approved by the Institutional Ethics Committee and informed consent was obtained from the study subjects.
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