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The Role of the CLIF-C OF and the 2016 MELD in Prognosis of Cirrhosis with and without Acute-on-Chronic Liver Failure.
Ann Hepatol. 2019 Jan - Feb; 18(1):48-57.AH

Abstract

INTRODUCTION AND AIM

Acute-on-chronic liver failure (ACLF) is defined by the development of acute deterioration of liver function associated with failure of other organs and high short-term mortality in patients with chronic liver disease (CLD). There is no consensus on the diagnostic criteria, and its independence from ordinary decompensation of CLD has frequently been questioned. This study aimed to identify and characterize this condition and to test the CLIF-C OF score comparing it to the 2016-MELD (with sodium) and the Child-Pugh.

MATERIAL AND METHODS

18-month prospective observational study with systematic inclusion of admitted patients with CLD decompensation.

RESULTS

39 patients had ACLF (33.1%). These patients experienced higher 28-day and 90-day mortality, when compared to patients without ACLF (43.6% and 64.1% vs. 2.5% and 7.6% respectively, p < 0.0001). ACLF was linked with a higher acute infection rate (74.4%). For all patients (N = 118), the scores 2016-MELD, CLIF-C OF and Child-Pugh showed an area under the curve (AUC) for 28-day mortality of 0.908, 0.844, 0.753 and for 90-day of 0.902, 0.814, 0.724 respectively, p < 0.0001 for all scores. The 90-day mortality 2016-MELD AUC was greater than the CLIF-C OF AUC, p = 0.021. Within ACLF patients, the 2016-MELD, CLIF-C ACLF and Child-Pugh scores showed an AUC of 0.774, 0.734, 0.584 (28-day) and 0.880, 0.771, 0.603 (90-day); for 2016-MELD p = 0.004 (28-day) and p < 0.0001 (90-day).

CONCLUSION

ACLF is a frequent and relevant condition, associated with high mortality. The CLIF-C OF score revealed good accuracy and diagnoses ACLF when it is present. However, the 2016-MELD performed better for 90-day mortality prediction.

Authors+Show Affiliations

Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal. Electronic address: davidperdigoto@gmail.com.Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.Gastroenterology Department, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

31113608

Citation

Perdigoto, David N., et al. "The Role of the CLIF-C of and the 2016 MELD in Prognosis of Cirrhosis With and Without Acute-on-Chronic Liver Failure." Annals of Hepatology, vol. 18, no. 1, 2019, pp. 48-57.
Perdigoto DN, Figueiredo P, Tomé L. The Role of the CLIF-C OF and the 2016 MELD in Prognosis of Cirrhosis with and without Acute-on-Chronic Liver Failure. Ann Hepatol. 2019;18(1):48-57.
Perdigoto, D. N., Figueiredo, P., & Tomé, L. (2019). The Role of the CLIF-C OF and the 2016 MELD in Prognosis of Cirrhosis with and without Acute-on-Chronic Liver Failure. Annals of Hepatology, 18(1), 48-57. https://doi.org/10.5604/01.3001.0012.7862
Perdigoto DN, Figueiredo P, Tomé L. The Role of the CLIF-C of and the 2016 MELD in Prognosis of Cirrhosis With and Without Acute-on-Chronic Liver Failure. Ann Hepatol. 2019 Jan - Feb;18(1):48-57. PubMed PMID: 31113608.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The Role of the CLIF-C OF and the 2016 MELD in Prognosis of Cirrhosis with and without Acute-on-Chronic Liver Failure. AU - Perdigoto,David N, AU - Figueiredo,Pedro, AU - Tomé,Luís, PY - 2017/10/05/received PY - 2017/11/16/accepted PY - 2019/5/23/entrez PY - 2019/5/23/pubmed PY - 2020/4/14/medline KW - CLIF-C ACLF KW - CLIF-C AD KW - Child-Pugh KW - MELD-Na KW - Prognostic scores SP - 48 EP - 57 JF - Annals of hepatology JO - Ann Hepatol VL - 18 IS - 1 N2 - INTRODUCTION AND AIM: Acute-on-chronic liver failure (ACLF) is defined by the development of acute deterioration of liver function associated with failure of other organs and high short-term mortality in patients with chronic liver disease (CLD). There is no consensus on the diagnostic criteria, and its independence from ordinary decompensation of CLD has frequently been questioned. This study aimed to identify and characterize this condition and to test the CLIF-C OF score comparing it to the 2016-MELD (with sodium) and the Child-Pugh. MATERIAL AND METHODS: 18-month prospective observational study with systematic inclusion of admitted patients with CLD decompensation. RESULTS: 39 patients had ACLF (33.1%). These patients experienced higher 28-day and 90-day mortality, when compared to patients without ACLF (43.6% and 64.1% vs. 2.5% and 7.6% respectively, p < 0.0001). ACLF was linked with a higher acute infection rate (74.4%). For all patients (N = 118), the scores 2016-MELD, CLIF-C OF and Child-Pugh showed an area under the curve (AUC) for 28-day mortality of 0.908, 0.844, 0.753 and for 90-day of 0.902, 0.814, 0.724 respectively, p < 0.0001 for all scores. The 90-day mortality 2016-MELD AUC was greater than the CLIF-C OF AUC, p = 0.021. Within ACLF patients, the 2016-MELD, CLIF-C ACLF and Child-Pugh scores showed an AUC of 0.774, 0.734, 0.584 (28-day) and 0.880, 0.771, 0.603 (90-day); for 2016-MELD p = 0.004 (28-day) and p < 0.0001 (90-day). CONCLUSION: ACLF is a frequent and relevant condition, associated with high mortality. The CLIF-C OF score revealed good accuracy and diagnoses ACLF when it is present. However, the 2016-MELD performed better for 90-day mortality prediction. SN - 1665-2681 UR - https://www.unboundmedicine.com/medline/citation/31113608/The_Role_of_the_CLIF_C_OF_and_the_2016_MELD_in_Prognosis_of_Cirrhosis_with_and_without_Acute_on_Chronic_Liver_Failure_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1665-2681(19)30306-0 DB - PRIME DP - Unbound Medicine ER -