Year 2017 / Volume 109 / Number 6
Original
CLIF-C ACLF score is a better mortality predictor than MELD, MELD-Na and CTP in patients with Acute on chronic liver failure admitted to the ward

399-405

DOI: 10.17235/reed.2017.4701/2016

Rita Barosa, Lídia Roque Ramos, Marta Patita, Gonçalo Nunes, Jorge Fonseca,

Abstract
Background and aims: Acute-on-chronic liver failure (ACLF) is a frequent syndrome associated with high mortality. The aims of the present study are: a) comparing the Chronic Liver Failure Consortium (CLIF-C) ACLF Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) scores for prediction of short/medium term mortality; b) identifying ACLF prevalence in patients admitted to the ward; and c) comparing mortality between non-ACLF/ACLF. Methods: Retrospective cohort study of 177 patients admitted to the Gastroenterology ward for acute decompensation of cirrhosis. Results: We included 132 males. Alcohol was the cirrhosis cause/co-factor in 79.7% of cases. Infection was present in 40.7%. At admission, 19.8% of patients presented ACLF and 7.9% developed it during hospitalization (overall prevalence was 27.7%). ACLF grade 1 was diagnosed in 55.1% of the ACLF patients; grade 2, in 42.8%, and grade 3, in 2.0%. Infection (p < 0.001) and hepatic encephalopathy (p = 0.004) were more prevalent and C-reactive protein and leukocyte counts were higher in ACLF patients. ACLF 28 and 90-day mortality was 45.8% and 60.4%, respectively. The CLIF-C ACLF score was significantly superior to CTP, MELD, MELD-Na in predicting 28-day (AUROC 0.799 ± 0.078, 95% CI 0.637-0.891) and 90-day mortality (AUROC 0.828 ± 0.063, 95% CI 0.705-0.952). Conclusion: ACLF is highly prevalent in the ward. The new CLIF scores identify high mortality cirrhotic patients admitted to the ward and are better than their predecessors to predict ACLF patients’ short/medium term mortality.
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References
1. Mathers CD, Loncar D. Projections of global mortality and burden of disease from 2002 to 2030. PLoS Med. 2006;3:e442. http://dx.doi.org/10.1371/journal.pmed.0030442
2. Zatoński WA, Sulkowska U, Mańczuk M, Rehm J, Boffetta P, Lowenfels AB, et al. Liver cirrhosis mortality in Europe, with special attention to Central and Eastern Europe. Eur Addict Res. 2010;16:193-201.
3. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144:1426-1437. http://dx.doi.org/10.1053/j.gastro.2013.02.042
4. Jalan R, Saliba F, Pavesi M, Amoros A, Moreau R, Ginès P, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol. 2014;61:1038-1047. http://dx.doi.org/10.1016/j.jhep.2014.06.012
5. Olson JC, Wendon JA, Kramer DJ, Arroyo V, Jalan R, Garcia-Tsao G, et al. Intensive care of the patient with cirrhosis. Hepatology. 2011;54:1864-1872.
6. Shawcross DL, Austin MJ, Abeles RD, McPhail MJ, Yeoman AD, Taylor NJ, et al. The impact of organ dysfunction in cirrhosis: survival at a cost? J Hepatol. 2012;56:1054-1062.
7. Jalan R, Gines P, Olson JC, Mookerjee RP, Moreau R, Garcia-Tsao G, et al. Acute-on chronic liver failure. J Hepatol. 2012;57:1336-1348. http://dx.doi.org/10.1002/hep.24622
8. McPhail MJ, Shawcross DL, Abeles RD, Chang A, Patel V, Lee GH, et al. Increased Survival for Patients With Cirrhosis and Organ Failure in Liver Intensive Care and Validation of the Chronic Liver Failure-Sequential Organ Failure Scoring System. Clin Gastroenterol Hepatol. 2015;13:1353-1360. http://dx.doi.org/10.1016/j.cgh.2014.08.041
9. Gustot T, Fernandez J, Garcia E, Morando F, Caraceni P, Alessandria C, et al. Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis. Hepatology. 2015;62:243-252. http://dx.doi.org/10.1002/hep.27849
10. Pugh RN, Murray-Lyon IM, Dawson JL, Pietroni MC, Williams R. Transection of the oesophagus for bleeding oesophageal varices. Br J Surg. 1973;60:646-649. http://dx.doi.org/10.1002/bjs.1800600817
11. Kamath PS, Wiesner RH, Malinchoc M, Kremers W, Therneau TM, Kosberg CL, et al. A model to predict survival in patients with end-stage liver disease. Hepatology. 2001;33:464-470. http://dx.doi.org/10.1053/jhep.2001.22172
12. Kim WR, Biggins SW, Kremers WK, Wiesner RH, Kamath PS, Benson JT, et al. Hyponatremia and mortality among patients on the liver-transplant waiting list. N Engl J Med. 2008;359:1018-1026. http://dx.doi.org/10.1056/NEJMoa0801209
13. Blei AT, Córdoba J, Gastroenterology PPCotACo. Hepatic Encephalopathy. Am J Gastroenterol. 2001;96:1968-1976. http://dx.doi.org/10.1111/j.1572-0241.2001.03964.x
14. Moore KP, Wong F, Gines P, Bernardi M, Ochs A, Salerno F, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology. 2003;38:258-266. http://dx.doi.org/10.1053/jhep.2003.50315
15. Garcia-Tsao G, Bosch J. Varices and Variceal Hemorrhage in Cirrhosis: A New View of an Old Problem. Clin Gastroenterol Hepatol. 2015;13:2109-2117. http://dx.doi.org/10.1016/j.cgh.2015.07.012
16. Thomson SJ, Berry PA, Rahman TM. The impact of organ dysfunction in cirrhosis: survival at a cost? J Hepatol. 2012;57:707-708; author reply 9. http://dx.doi.org/10.1016/j.jhep.2012.03.032
17. Organization WH. Global Status Report on Alcohol and Health. 2014 - ed.
18. Strauss E, da Costa MF. The importance of bacterial infections as precipating factors of chronic hepatic encephalopathy in cirrhosis. Hepatogastroenterology. 1998;45:900-904.
19. Sort P, Navasa M, Arroyo V, Aldeguer X, Planas R, Ruiz-del-Arbol L, et al. Effect of intravenous albumin on renal impairment and mortality in patients with cirrhosis and spontaneous bacterial peritonitis. N Engl J Med. 1999;341:403-409. http://dx.doi.org/10.1056/NEJM199908053410603
20. Solà E, Ginès P. Challenges and Management of Liver Cirrhosis: Pathophysiology of Renal Dysfunction in Cirrhosis. Dig Dis. 2015;33:534-538. http://dx.doi.org/10.1159/000375344
21. Angeli P, Gines P, Wong F, Bernardi M, Boyer TD, Gerbes A, et al. Diagnosis and management of acute kidney injury in patients with cirrhosis: revised consensus recommendations of the International Club of Ascites. Gut. 2015;64:531-537. http://dx.doi.org/10.1136/gutjnl-2014-308874
22. Gao F, Melody T, Daniels DF, Giles S, Fox S. The impact of compliance with 6-hour and 24-hour sepsis bundles on hospital mortality in patients with severe sepsis: a prospective observational study. Crit Care. 2005;9:764-770.
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Barosa R, Roque Ramos L, Patita M, Nunes G, Fonseca J. CLIF-C ACLF score is a better mortality predictor than MELD, MELD-Na and CTP in patients with Acute on chronic liver failure admitted to the ward. 4701/2016


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Publication history

Received: 01/11/2016

Accepted: 10/02/2017

Online First: 03/05/2017

Published: 01/06/2017

Article revision time: 95 days

Article Online First time: 183 days

Article editing time: 212 days


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