Background & Aims
Cirrhotic patients with acute decompensation frequently develop acute-on-chronic liver failure (ACLF), which is associated with high mortality rates. Recently, a specific score for these patients has been developed using the CANONIC study database. The aims of this study were to develop and validate the CLIF-C AD score, a specific prognostic score for hospitalised cirrhotic patients with acute decompensation (AD), but without ACLF, and to compare this with the Child-Pugh, MELD, and MELD-Na scores.
The derivation set included 1016 CANONIC study patients without ACLF. Proportional hazards models considering liver transplantation as a competing risk were used to identify score parameters. Estimated coefficients were used as relative weights to compute the CLIF-C ADs. External validation was performed in 225 cirrhotic AD patients. CLIF-C ADs was also tested for sequential use.
Age, serum sodium, white-cell count, creatinine and INR were selected as the best predictors of mortality. The C-index for prediction of mortality was better for CLIF-C ADs compared with Child-Pugh, MELD, and MELD-Nas at predicting 3- and 12-month mortality in the derivation, internal validation and the external dataset. CLIF-C ADs improved in its ability to predict 3-month mortality using data from days 2, 3–7, and 8–15 (C-index: 0.72, 0.75, and 0.77 respectively).
The new CLIF-C ADs is more accurate than other liver scores in predicting prognosis in hospitalised cirrhotic patients without ACLF. CLIF-C ADs therefore may be used to identify a high-risk cohort for intensive management and a low-risk group that may be discharged early.
Abbreviations:ACLF (acute-on-chronic liver failure), AD (acute decompensation), CANONIC study (EASL-CLIF Acute oN chrONIC liver failure study), CLIF (Chronic Liver Failure), CLIF-C ACLFs (CLIF-CONSORTIUM ACLF score), CLIF-C OFs (CLIF-Consortium Organ Failure score), CLIF-SOFAs (CLIF-Sequential Organ Failure Assessment score), CPs (Child-Pugh score), E (epinephrine), EASL (European Association for the Study of the Liver), FIO2 (fraction of inspired oxygen), HE (hepatic encephalopathy), INR (International Normalized Ratio), MAP (mean arterial pressure), MELDs (Model of End-Stage Liver Disease), MELD-Nas (MELD-Sodium score), NE (norepinephrine), PaO2 (partial pressure of arterial oxygen), SOFA (Sequential Organ Failure Assessment), SpO2 (pulse oximetric saturation)
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Published online: November 21, 2014
Accepted: November 4, 2014
Received in revised form: October 28, 2014
Received: July 23, 2014
© 2015 European Association for the Study of the Liver. Published by Elsevier Inc. All rights reserved.