[ABC prognostic classification and MELD 3.0 and COSSH-ACLF Ⅱ prognostic evaluation in acute-on-chronic liver failure]

Area of Science:

• Hepatology and Gastroenterology
• Clinical Prognostics
• Liver Disease Research

Context:

• Acute-on-chronic liver failure (ACLF) presents complex prognostic challenges.
• Existing scoring systems like MELD require refinement for improved predictive accuracy in ACLF.
• The ABC classification system offers a framework for stratifying ACLF severity.

Purpose:

• To evaluate the prognostic performance of the ABC classification system in ACLF.
• To compare the predictive capabilities of the Model for End-stage Liver Disease (MELD) score 3.0 and the COSSH-ACLF II score for ACLF prognosis.
• To assess the early predictive value of the COSSH-ACLF II score within 3 days of hospitalization.

Summary:

• The ABC classification significantly stratifies ACLF patient survival.
• The COSSH-ACLF II score demonstrated superior prognostic predictive ability compared to MELD and MELD 3.0, with Area Under the Receiver Operating Characteristic Curve (AUROC) values of 0.817 and 0.839, respectively.
• The COSSH-ACLF II score showed enhanced predictive accuracy for Class A ACLF and Hepatitis B virus-related ACLF (HBV-ACLF), with AUROCs of 0.877 and 0.881, respectively, and improved performance when assessed 3 days post-admission.

Impact:

• The findings highlight the clinical utility of the COSSH-ACLF II score for early and accurate prognostic evaluation in ACLF patients.
• Early identification of high-risk ACLF patients can guide timely therapeutic interventions.
• The study underscores the importance of considering specific etiological factors, such as HBV, in ACLF prognosis.