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Chronic liver failure-consortium acute-on-chronic liver failure and acute decompensation scores predict mortality in Brazilian cirrhotic patients.
World J Gastroenterol. 2017 Jul 28; 23(28):5237-5245.WJ

Abstract

AIM

To validate prognostic scores for acute decompensation of cirrhosis and acute-on-chronic liver failure in Brazilian patients.

METHODS

This is a prospective cohort study designed to assess the prognostic performance of the chronic liver failure-consortium (CLIF-C) acute decompensation score (CLIF-C AD) and CLIF-C acute-on-chronic liver failure score (CLIF-C ACLF), regarding 28-d and 90-d mortality, as well as to compare them to other prognostic models, such as Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na), Child-Pugh (CP) score, and the CLIF-C Organ Failure score (CLIF-C OF). All participants were adults with acute decompensation of cirrhosis admitted to the Emergency Department of a tertiary hospital in southern Brazil. Prognostic performances were evaluated by means of the receiver operating characteristic (ROC) curves, area under the curves (AUC) and 95%CI.

RESULTS

One hundred and thirteen cirrhotic patients were included. At admission, 18 patients had acute-on-chronic liver failure (ACLF) and 95 individuals had acute decompensation (AD) without ACLF, of which 24 eventually developed ACLF during the course of hospitalization (AD evolving to ACLF group). The AD group had significantly lower 28-d (9.0%) and 90-d (18.3%) mortality as compared to the AD evolving to ACLF group and to the ACLF group (both P < 0.001). On the other hand, 28-d and 90-d mortalities were not significantly different between AD evolving to ACLF group and ACLF group (P = 0.542 and P = 0.708, respectively). Among patients with ACLF, at 28 d from the diagnosis, CLIF-C ACLF was the only score able to predict mortality significantly better than the reference line, with an AUC (95%CI) of 0.71 (95%CI: 0.54-0.88, P = 0.021). Among patients with AD, all prognostic scores performed significantly better than the reference line regarding 28-d mortality, presenting with similar AUCs: CLIF-C AD score 0.75 (95%CI: 0.63-0.88), CP score 0.72 (95%CI: 0.59-0.85), MELD score 0.75 (95%CI: 0.61-0.90), MELD-Na score 0.76 (95%CI: 0.61-0.90), and CLIF-C OF score 0.74 (95%CI: 0.60-0.88). The same occurred concerning AUCs for 90-d mortality: CLIF-C AD score 0.70 (95%CI: 0.57-0.82), CP score 0.73 (95%CI: 0.62-0.84), MELD score 0.71 (95%CI: 0.59-0.83), MELD-Na score 0.73 (95%CI: 0.62-0.84), and CLIF-C OF score 0.65 (95%CI: 0.52-0.78).

CONCLUSION

This study demonstrated that CLIF-C ACLF is the best available score for the prediction of 28-d mortality among patients with ACLF. CLIF-C AD score is also useful for the prediction of mortality among cirrhotic patients with AD not fulfilling diagnostic criteria for ACLF, but it was not superior to other well-established prognostic scores.

Authors+Show Affiliations

Rafael Veiga Picon, Franciele Sabadin Bertol, Cristiane Valle Tovo, Gastroenterology and Hepatology Unit, Nossa Senhora da Conceição Hospital, Porto Alegre, Rio Grande do Sul 91350-200, Brazil.Rafael Veiga Picon, Franciele Sabadin Bertol, Cristiane Valle Tovo, Gastroenterology and Hepatology Unit, Nossa Senhora da Conceição Hospital, Porto Alegre, Rio Grande do Sul 91350-200, Brazil.Rafael Veiga Picon, Franciele Sabadin Bertol, Cristiane Valle Tovo, Gastroenterology and Hepatology Unit, Nossa Senhora da Conceição Hospital, Porto Alegre, Rio Grande do Sul 91350-200, Brazil.Rafael Veiga Picon, Franciele Sabadin Bertol, Cristiane Valle Tovo, Gastroenterology and Hepatology Unit, Nossa Senhora da Conceição Hospital, Porto Alegre, Rio Grande do Sul 91350-200, Brazil.

Pub Type(s)

Comparative Study
Journal Article
Validation Study

Language

eng

PubMed ID

28811718

Citation

Picon, Rafael Veiga, et al. "Chronic Liver Failure-consortium Acute-on-chronic Liver Failure and Acute Decompensation Scores Predict Mortality in Brazilian Cirrhotic Patients." World Journal of Gastroenterology, vol. 23, no. 28, 2017, pp. 5237-5245.
Picon RV, Bertol FS, Tovo CV, et al. Chronic liver failure-consortium acute-on-chronic liver failure and acute decompensation scores predict mortality in Brazilian cirrhotic patients. World J Gastroenterol. 2017;23(28):5237-5245.
Picon, R. V., Bertol, F. S., Tovo, C. V., & de Mattos, Â. Z. (2017). Chronic liver failure-consortium acute-on-chronic liver failure and acute decompensation scores predict mortality in Brazilian cirrhotic patients. World Journal of Gastroenterology, 23(28), 5237-5245. https://doi.org/10.3748/wjg.v23.i28.5237
Picon RV, et al. Chronic Liver Failure-consortium Acute-on-chronic Liver Failure and Acute Decompensation Scores Predict Mortality in Brazilian Cirrhotic Patients. World J Gastroenterol. 2017 Jul 28;23(28):5237-5245. PubMed PMID: 28811718.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Chronic liver failure-consortium acute-on-chronic liver failure and acute decompensation scores predict mortality in Brazilian cirrhotic patients. AU - Picon,Rafael Veiga, AU - Bertol,Franciele Sabadin, AU - Tovo,Cristiane Valle, AU - de Mattos,Ângelo Zambam, PY - 2017/03/15/received PY - 2017/05/30/revised PY - 2017/07/12/accepted PY - 2017/8/17/entrez PY - 2017/8/16/pubmed PY - 2018/5/11/medline KW - Acute decompensation of cirrhosis KW - Acute-on-chronic liver failure KW - Cirrhosis KW - Mortality KW - Prediction KW - Prognosis SP - 5237 EP - 5245 JF - World journal of gastroenterology JO - World J. Gastroenterol. VL - 23 IS - 28 N2 - AIM: To validate prognostic scores for acute decompensation of cirrhosis and acute-on-chronic liver failure in Brazilian patients. METHODS: This is a prospective cohort study designed to assess the prognostic performance of the chronic liver failure-consortium (CLIF-C) acute decompensation score (CLIF-C AD) and CLIF-C acute-on-chronic liver failure score (CLIF-C ACLF), regarding 28-d and 90-d mortality, as well as to compare them to other prognostic models, such as Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na), Child-Pugh (CP) score, and the CLIF-C Organ Failure score (CLIF-C OF). All participants were adults with acute decompensation of cirrhosis admitted to the Emergency Department of a tertiary hospital in southern Brazil. Prognostic performances were evaluated by means of the receiver operating characteristic (ROC) curves, area under the curves (AUC) and 95%CI. RESULTS: One hundred and thirteen cirrhotic patients were included. At admission, 18 patients had acute-on-chronic liver failure (ACLF) and 95 individuals had acute decompensation (AD) without ACLF, of which 24 eventually developed ACLF during the course of hospitalization (AD evolving to ACLF group). The AD group had significantly lower 28-d (9.0%) and 90-d (18.3%) mortality as compared to the AD evolving to ACLF group and to the ACLF group (both P < 0.001). On the other hand, 28-d and 90-d mortalities were not significantly different between AD evolving to ACLF group and ACLF group (P = 0.542 and P = 0.708, respectively). Among patients with ACLF, at 28 d from the diagnosis, CLIF-C ACLF was the only score able to predict mortality significantly better than the reference line, with an AUC (95%CI) of 0.71 (95%CI: 0.54-0.88, P = 0.021). Among patients with AD, all prognostic scores performed significantly better than the reference line regarding 28-d mortality, presenting with similar AUCs: CLIF-C AD score 0.75 (95%CI: 0.63-0.88), CP score 0.72 (95%CI: 0.59-0.85), MELD score 0.75 (95%CI: 0.61-0.90), MELD-Na score 0.76 (95%CI: 0.61-0.90), and CLIF-C OF score 0.74 (95%CI: 0.60-0.88). The same occurred concerning AUCs for 90-d mortality: CLIF-C AD score 0.70 (95%CI: 0.57-0.82), CP score 0.73 (95%CI: 0.62-0.84), MELD score 0.71 (95%CI: 0.59-0.83), MELD-Na score 0.73 (95%CI: 0.62-0.84), and CLIF-C OF score 0.65 (95%CI: 0.52-0.78). CONCLUSION: This study demonstrated that CLIF-C ACLF is the best available score for the prediction of 28-d mortality among patients with ACLF. CLIF-C AD score is also useful for the prediction of mortality among cirrhotic patients with AD not fulfilling diagnostic criteria for ACLF, but it was not superior to other well-established prognostic scores. SN - 2219-2840 UR - https://www.unboundmedicine.com/medline/citation/28811718/Chronic_liver_failure_consortium_acute_on_chronic_liver_failure_and_acute_decompensation_scores_predict_mortality_in_Brazilian_cirrhotic_patients_ L2 - http://www.wjgnet.com/1007-9327/full/v23/i28/5237.htm DB - PRIME DP - Unbound Medicine ER -