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Comparing CLIF-C ACLF, CLIF-C ACLFlactate, and CLIF-C ACLF-D Prognostic Scores in Acute-on-Chronic Liver Failure

Chao-Cheng Kuo1, Chien-Hao Huang1,2, Ching Chang1

  • 1Division of Hepatology, Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333423, Taiwan.

Journal of Personalized Medicine
|February 12, 2021
PubMed

Insights

The CLIF-C ACLF-D score is a superior predictor of mortality in patients with acute-on-chronic liver failure (ACLF). This prognostic tool aids in evaluating outcomes for liver cirrhosis patients awaiting transplantation.

Area of Science:

  • Hepatology
  • Critical Care Medicine
  • Prognostic Biomarkers

Background:

  • Patients with liver cirrhosis face a heightened risk of developing acute-on-chronic liver failure (ACLF).
  • ACLF presents a poor prognosis with high short-term mortality, limiting liver transplant opportunities.
  • Accurate prognostic evaluation is crucial for ACLF patients before transplant consideration.

Purpose of the Study:

  • To compare the predictive performance of three prognostic scores for ACLF patients.
  • To evaluate the CLIF-C ACLF, CLIF-C ACLF-D, and CLIF-C ACLFlactate scores in predicting mortality.
  • To identify the most effective score for assessing outcomes in critical ACLF.

Main Methods:

  • A cohort of 135 ACLF patients admitted to CGMH (Taiwan) from Nov 2012 to Apr 2015 were tracked until Apr 2017.
  • Three prognostic scores (CLIF-C ACLF, CLIF-C ACLF-D, CLIF-C ACLFlactate) were assessed.
  • Area Under the Receiver Operating Characteristic Curve (AUROC) analysis was used to compare mortality predictions at various time points (28 days to 365 days).

Main Results:

  • CLIF-C ACLF and CLIF-C ACLF-D scores outperformed CLIF-C ACLFlactate in predicting 28-day mortality.
  • The CLIF-C ACLF-D score demonstrated the highest AUROC for overall mortality prediction.
  • CLIF-C ACLF-D also showed superior predictive power for 90, 180, and 365-day mortality.

Conclusions:

  • CLIF-C ACLF and CLIF-C ACLF-D scores are significant predictors of outcomes in critically ill liver cirrhosis patients with ACLF.
  • The CLIF-C ACLF-D score exhibits superior predictive capability for short-term and long-term mortality (3 months to 1 year).
  • This study highlights the utility of CLIF-C ACLF-D for prognostic assessment in ACLF management.

Keywords:
CLIF-C ACLFCLIF-C ACLF-Dacute-on-chronic liver failure (ACLF)area under the ROC curve (AUROC)error barsintensive care unitlactate-adjusted CLIF-C ACLFs (CLIF-C ACLFlactate score)liver cirrhosis

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