Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure

Rajiv Jalan, Faouzi Saliba, Marco Pavesi, Alex Amoros, Richard Moreau, Pere Ginès, Eric Levesque, Francois Durand, Paolo Angeli, Paolo Caraceni, Corinna Hopf, Carlo Alessandria, Ezequiel Rodriguez, Pablo Solis-Muñoz, Wim Laleman, Jonel Trebicka, Stefan Zeuzem, Thierry Gustot, Rajeshwar Mookerjee, Laure Elkrief, German Soriano, Joan Cordoba, Filippo Morando, Alexander Gerbes, Banwari Agarwal, Didier Samuel, Mauro Bernardi, Vicente Arroyo
Journal of Hepatology 2014, 61 (5): 1038-47

BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is a frequent syndrome (30% prevalence), characterized by acute decompensation of cirrhosis, organ failure(s) and high short-term mortality. This study develops and validates a specific prognostic score for ACLF patients.

METHODS: Data from 1349 patients included in the CANONIC study were used. First, a simplified organ function scoring system (CLIF Consortium Organ Failure score, CLIF-C OFs) was developed to diagnose ACLF using data from all patients. Subsequently, in 275 patients with ACLF, CLIF-C OFs and two other independent predictors of mortality (age and white blood cell count) were combined to develop a specific prognostic score for ACLF (CLIF Consortium ACLF score [CLIF-C ACLFs]). A concordance index (C-index) was used to compare the discrimination abilities of CLIF-C ACLF, MELD, MELD-sodium (MELD-Na), and Child-Pugh (CPs) scores. The CLIF-C ACLFs was validated in an external cohort and assessed for sequential use.

RESULTS: The CLIF-C ACLFs showed a significantly higher predictive accuracy than MELDs, MELD-Nas, and CPs, reducing (19-28%) the corresponding prediction error rates at all main time points after ACLF diagnosis (28, 90, 180, and 365 days) in both the CANONIC and the external validation cohort. CLIF-C ACLFs computed at 48 h, 3-7 days, and 8-15 days after ACLF diagnosis predicted the 28-day mortality significantly better than at diagnosis.

CONCLUSIONS: The CLIF-C ACLFs at ACLF diagnosis is superior to the MELDs and MELD-Nas in predicting mortality. The CLIF-C ACLFs is a clinically relevant, validated scoring system that can be used sequentially to stratify the risk of mortality in ACLF patients.

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