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Chronic Liver Failure-Sequential Organ Failure Assessment is better than the Asia-Pacific Association for the Study of Liver criteria for defining acute-on-chronic liver failure and predicting outcome.
World J Gastroenterol. 2014 Oct 28; 20(40):14934-41.WJ

Abstract

AIM

To compare the utility of the Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) and Asia-Pacific Association for the Study of Liver (APASL) definitions of acute-on-chronic liver failure (ACLF) in predicting short-term prognosis of patients with ACLF.

METHODS

Consecutive patients of cirrhosis with acute decompensation were prospectively included. They were grouped into ACLF and no ACLF groups as per CLIF-SOFA and APASL criteria. Patients were followed up for 3 mo from inclusion or mortality whichever was earlier. Mortality at 28-d and 90-d was compared between no ACLF and ACLF groups as per both criteria. Mortality was also compared between different grades of ACLF as per CLIF-SOFA criteria. Prognostic scores like CLIF-SOFA, Acute Physiology and Chronic Health Evaluation (APACHE)-II, Child-Pugh and Model for End-Stage Liver Disease (MELD) scores were evaluated for their ability to predict 28-d mortality using area under receiver operating curves (AUROC).

RESULTS

Of 50 patients, 38 had ACLF as per CLIF-SOFA and 19 as per APASL criteria. Males (86%) were predominant, alcoholic liver disease (68%) was the most common etiology of cirrhosis, sepsis (66%) was the most common cause of acute decompensation while infection (66%) was the most common precipitant of acute decompensation. The 28-d mortality in no ACLF and ACLF groups was 8.3% and 47.4% (P = 0.018) as per CLIF-SOFA and 39% and 37% (P = 0.895) as per APASL criteria. The 28-d mortality in patients with no ACLF (n = 12), ACLF grade 1 (n = 11), ACLF grade 2 (n = 14) and ACLF grade 3 (n = 13) as per CLIF-SOFA criteria was 8.3%, 18.2%, 42.9% and 76.9% (χ(2) for trend, P = 0.002) and 90-d mortality was 16.7%, 27.3%, 78.6% and 100% (χ(2) for trend, P < 0.0001) respectively. Patients with prior decompensation had similar 28-d and 90-d mortality (39.3% and 53.6%) as patients without prior decompensation (36.4% and 63.6%) (P = NS). AUROCs for 28-d mortality were 0.795, 0.787, 0.739 and 0.710 for CLIF-SOFA, APACHE-II, Child-Pugh and MELD scores respectively. On multivariate analysis of these scores, CLIF-SOFA was the only significant independent predictor of mortality with an odds ratio 1.538 (95%CI: 1.078-2.194).

CONCLUSION

CLIF-SOFA criteria is better than APASL criteria to classify patients into ACLF based on their prognosis. CLIF-SOFA score is the best predictor of short-term mortality.

Authors+Show Affiliations

Radha K Dhiman, Swastik Agrawal, Tarana Gupta, Ajay Duseja, Yogesh Chawla, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.Radha K Dhiman, Swastik Agrawal, Tarana Gupta, Ajay Duseja, Yogesh Chawla, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.Radha K Dhiman, Swastik Agrawal, Tarana Gupta, Ajay Duseja, Yogesh Chawla, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.Radha K Dhiman, Swastik Agrawal, Tarana Gupta, Ajay Duseja, Yogesh Chawla, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.Radha K Dhiman, Swastik Agrawal, Tarana Gupta, Ajay Duseja, Yogesh Chawla, Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh 160012, India.

Pub Type(s)

Comparative Study
Journal Article
Observational Study

Language

eng

PubMed ID

25356054

Citation

Dhiman, Radha K., et al. "Chronic Liver Failure-Sequential Organ Failure Assessment Is Better Than the Asia-Pacific Association for the Study of Liver Criteria for Defining Acute-on-chronic Liver Failure and Predicting Outcome." World Journal of Gastroenterology, vol. 20, no. 40, 2014, pp. 14934-41.
Dhiman RK, Agrawal S, Gupta T, et al. Chronic Liver Failure-Sequential Organ Failure Assessment is better than the Asia-Pacific Association for the Study of Liver criteria for defining acute-on-chronic liver failure and predicting outcome. World J Gastroenterol. 2014;20(40):14934-41.
Dhiman, R. K., Agrawal, S., Gupta, T., Duseja, A., & Chawla, Y. (2014). Chronic Liver Failure-Sequential Organ Failure Assessment is better than the Asia-Pacific Association for the Study of Liver criteria for defining acute-on-chronic liver failure and predicting outcome. World Journal of Gastroenterology, 20(40), 14934-41. https://doi.org/10.3748/wjg.v20.i40.14934
Dhiman RK, et al. Chronic Liver Failure-Sequential Organ Failure Assessment Is Better Than the Asia-Pacific Association for the Study of Liver Criteria for Defining Acute-on-chronic Liver Failure and Predicting Outcome. World J Gastroenterol. 2014 Oct 28;20(40):14934-41. PubMed PMID: 25356054.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic Liver Failure-Sequential Organ Failure Assessment is better than the Asia-Pacific Association for the Study of Liver criteria for defining acute-on-chronic liver failure and predicting outcome. AU - Dhiman,Radha K, AU - Agrawal,Swastik, AU - Gupta,Tarana, AU - Duseja,Ajay, AU - Chawla,Yogesh, PY - 2014/03/25/received PY - 2014/05/08/revised PY - 2014/06/12/accepted PY - 2014/10/31/entrez PY - 2014/10/31/pubmed PY - 2015/8/14/medline KW - Acute decompensation KW - Acute on chronic liver failure KW - Cirrhosis KW - Mortality KW - Prognosis SP - 14934 EP - 41 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 20 IS - 40 N2 - AIM: To compare the utility of the Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) and Asia-Pacific Association for the Study of Liver (APASL) definitions of acute-on-chronic liver failure (ACLF) in predicting short-term prognosis of patients with ACLF. METHODS: Consecutive patients of cirrhosis with acute decompensation were prospectively included. They were grouped into ACLF and no ACLF groups as per CLIF-SOFA and APASL criteria. Patients were followed up for 3 mo from inclusion or mortality whichever was earlier. Mortality at 28-d and 90-d was compared between no ACLF and ACLF groups as per both criteria. Mortality was also compared between different grades of ACLF as per CLIF-SOFA criteria. Prognostic scores like CLIF-SOFA, Acute Physiology and Chronic Health Evaluation (APACHE)-II, Child-Pugh and Model for End-Stage Liver Disease (MELD) scores were evaluated for their ability to predict 28-d mortality using area under receiver operating curves (AUROC). RESULTS: Of 50 patients, 38 had ACLF as per CLIF-SOFA and 19 as per APASL criteria. Males (86%) were predominant, alcoholic liver disease (68%) was the most common etiology of cirrhosis, sepsis (66%) was the most common cause of acute decompensation while infection (66%) was the most common precipitant of acute decompensation. The 28-d mortality in no ACLF and ACLF groups was 8.3% and 47.4% (P = 0.018) as per CLIF-SOFA and 39% and 37% (P = 0.895) as per APASL criteria. The 28-d mortality in patients with no ACLF (n = 12), ACLF grade 1 (n = 11), ACLF grade 2 (n = 14) and ACLF grade 3 (n = 13) as per CLIF-SOFA criteria was 8.3%, 18.2%, 42.9% and 76.9% (χ(2) for trend, P = 0.002) and 90-d mortality was 16.7%, 27.3%, 78.6% and 100% (χ(2) for trend, P < 0.0001) respectively. Patients with prior decompensation had similar 28-d and 90-d mortality (39.3% and 53.6%) as patients without prior decompensation (36.4% and 63.6%) (P = NS). AUROCs for 28-d mortality were 0.795, 0.787, 0.739 and 0.710 for CLIF-SOFA, APACHE-II, Child-Pugh and MELD scores respectively. On multivariate analysis of these scores, CLIF-SOFA was the only significant independent predictor of mortality with an odds ratio 1.538 (95%CI: 1.078-2.194). CONCLUSION: CLIF-SOFA criteria is better than APASL criteria to classify patients into ACLF based on their prognosis. CLIF-SOFA score is the best predictor of short-term mortality. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/25356054/Chronic_Liver_Failure_Sequential_Organ_Failure_Assessment_is_better_than_the_Asia_Pacific_Association_for_the_Study_of_Liver_criteria_for_defining_acute_on_chronic_liver_failure_and_predicting_outcome_ L2 - http://www.wjgnet.com/1007-9327/full/v20/i40/14934.htm DB - PRIME DP - Unbound Medicine ER -