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Assessing the Prediction Effect of Various Prognosis Model for 28-Day Mortality in Acute-on-Chronic Liver Failure
Lin Xiang Liu1, Yue Zhang1, Yuan Nie1
1Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, People's Republic of China.
Background:
Acute-on-chronic liver failure (ACLF) is an extremely clinical entity associated with short-term high mortality. The CLIF-SOFA score measures both hepatic and extrahepatic organ dysfunction and can discriminate significantly better between survivors and nonsurvivors compared to other methods. The MELD score is widely used for organ allocation in liver transplantation. Recent reports indicate that the PWR is a potential biomarker for predicting clinical outcomes. The ALBI score is a new score model for evaluating the severity of liver dysfunction. We aimed to compare these prognosis models to predict short-term mortality in ACLF patients.
Methods:
A retrospective analysis of 89 ACLF patients between 2015 and 2018 was performed. The receiver operating characteristic (ROC) curve was used to assess the power of four prognosis models for predicting 28-day mortality in patients with ACLF.
Results:
The ALBI score, MELD score and CLIF-SOFA score were significantly higher, and the PWR was slightly lower in nonsurviving ACLF patients than in surviving patients. The MELD score and ALBI score were positively correlated with the CLIF-SOFA score, while the PWR was inversely related to the CLIF-SOFA score. The area under the ROC curves (AUROCS) of the CLIF-SOFA score, PWR, ALBI score and MELD score were 0.804, 0.759, 0.710 and 0.670, respectively.
Conclusion:
The CLIF-SOFA score, PWR and ALBI score can better predict 28-day mortality in ACLF patients, but the MELD score has worse predictability. The CLIF-SOFA score is the best prognosis model among these models. PWR may be a simple and useful tool that can predict 28-day outcome.
Insights
The CLIF-SOFA score is the best model for predicting short-term mortality in acute-on-chronic liver failure (ACLF) patients. Other models like PWR and ALBI also show promise, while the MELD score is less effective.
Area of Science:
- Hepatology
- Critical Care Medicine
- Prognostic Biomarkers
Background:
- Acute-on-chronic liver failure (ACLF) presents a significant clinical challenge with high short-term mortality.
- Existing prognostic models include the CLIF-SOFA score for organ dysfunction and the MELD score for liver transplant allocation.
- Emerging biomarkers like the Platelet-to-WBC Ratio (PWR) and the Albumin-Bilirubin (ALBI) score are being investigated for their predictive capabilities.
Purpose of the Study:
- To compare the predictive accuracy of the CLIF-SOFA score, MELD score, PWR, and ALBI score for 28-day mortality in ACLF patients.
- To identify the most effective prognostic model for stratifying risk in ACLF.
Main Methods:
- A retrospective analysis of 89 ACLF patients diagnosed between 2015 and 2018.
- Receiver operating characteristic (ROC) curve analysis was employed to evaluate the predictive performance of each model.
Main Results:
- Nonsurvivors exhibited significantly higher ALBI, MELD, and CLIF-SOFA scores, and a lower PWR compared to survivors.
- The CLIF-SOFA score demonstrated the highest predictive accuracy (AUROC 0.804), followed by PWR (0.759), ALBI (0.710), and MELD (0.670).
- The MELD and ALBI scores correlated positively with the CLIF-SOFA score, whereas PWR showed an inverse relationship.
Conclusions:
- The CLIF-SOFA score, PWR, and ALBI score are superior to the MELD score in predicting 28-day mortality in ACLF.
- The CLIF-SOFA score is identified as the optimal prognostic model among those evaluated.
- PWR emerges as a potentially simple and valuable tool for predicting short-term outcomes in ACLF.
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