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Dynamic Changes in Bilirubin Predict 90-Day Mortality in Patients With Hepatocellular Carcinoma and Acute

Oliver Moore1,2, Fran Neveu-Coble3,4, Scott Read1,2,3

  • 1Blacktown Clinical School, School of Medicine, Western Sydney University, Blacktown, New South Wales, Australia.

Mayo Clinic Proceedings. Innovations, Quality & Outcomes
|October 24, 2025
PubMed

Insights

A new HCC-AD score predicts 90-day mortality in hepatocellular carcinoma (HCC) patients with acute decompensation (AD). This simple bilirubin-based score effectively stratifies risk and outperforms existing models in advanced HCC.

Area of Science:

  • Hepatology
  • Oncology
  • Clinical Prediction Modeling

Background:

  • Hepatocellular carcinoma (HCC) patients with acute decompensation (AD) of chronic liver disease face high 90-day mortality.
  • Accurate prediction of mortality is crucial for timely intervention and resource allocation.

Purpose of the Study:

  • To develop and validate a novel score, the HCC-acute decompensation (AD) score, to predict 90-day mortality in HCC patients admitted with AD.
  • To compare the performance of the HCC-AD score against existing prognostic models.

Main Methods:

  • Retrospective cohort study of 355 patients with decompensated cirrhosis and HCC.
  • Data collected at admission and day 7, including bilirubin levels.
  • Classification and regression tree analysis used to develop the HCC-AD score; discrimination assessed using Harrell C statistic.

Main Results:

  • The HCC-AD score, based on admission and 7-day change in bilirubin, stratified patients into three risk groups with predicted 90-day mortality of 26%, 49%, and 89%.
  • The score demonstrated good discrimination (Harrell C=0.731) in the validation cohort.
  • The HCC-AD score was predictive across Barcelona Clinic Liver Cancer (BCLC) stages B, C, and D, outperforming MELD 3.0 and Child-Pugh scores in BCLC D.

Conclusions:

  • The HCC-AD score is a simple, effective tool for stratifying 90-day mortality risk in HCC patients with AD.
  • This score shows superiority over existing models, particularly in advanced HCC stages (BCLC C and D).
  • The HCC-AD score can aid clinical decision-making and patient management in this high-risk population.
Abstract

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