• Rajiv Jalan, Faouzi Saliba, Marco Pavesi, Alex Amoros, Richard Moreau, Pere Ginès, Eric Levesque, Francois Durand, Paolo Angeli, Paolo Caraceni, Corinna Hopf, Carlo Alessandria, Ezequiel Rodriguez, Pablo Solis-Muñoz, Wim Laleman, Jonel Trebicka, Stefan Zeuzem, Thierry Gustot, Rajeshwar Mookerjee, Laure Elkrief, German Soriano, Joan Cordoba, Filippo Morando, Alexander Gerbes, Banwari Agarwal, Didier Samuel, Mauro Bernardi, Vicente Arroyo, and CANONIC study investigators of the EASL-CLIF Consortium.
• Liver Failure Group, UCL Institute for Liver and Digestive Health, UCL Medical School, Royal Free Hospital, London, United Kingdom.
• J. Hepatol. 2014 Nov 1;61(5):1038-47.

Background & AimsAcute-on-chronic liver failure (ACLF) is a frequent syndrome (30% prevalence), characterized by acute decompensation of cirrhosis, organ failure(s) and high short-term mortality. This study develops and validates a specific prognostic score for ACLF patients.MethodsData from 1349 patients included in the CANONIC study were used. First, a simplified organ function scoring system (CLIF Consortium Organ Failure score, CLIF-C OFs) was developed to diagnose ACLF using data from all patients. Subsequently, in 275 patients with ACLF, CLIF-C OFs and two other independent predictors of mortality (age and white blood cell count) were combined to develop a specific prognostic score for ACLF (CLIF Consortium ACLF score [CLIF-C ACLFs]). A concordance index (C-index) was used to compare the discrimination abilities of CLIF-C ACLF, MELD, MELD-sodium (MELD-Na), and Child-Pugh (CPs) scores. The CLIF-C ACLFs was validated in an external cohort and assessed for sequential use.ResultsThe CLIF-C ACLFs showed a significantly higher predictive accuracy than MELDs, MELD-Nas, and CPs, reducing (19-28%) the corresponding prediction error rates at all main time points after ACLF diagnosis (28, 90, 180, and 365 days) in both the CANONIC and the external validation cohort. CLIF-C ACLFs computed at 48 h, 3-7 days, and 8-15 days after ACLF diagnosis predicted the 28-day mortality significantly better than at diagnosis.ConclusionsThe CLIF-C ACLFs at ACLF diagnosis is superior to the MELDs and MELD-Nas in predicting mortality. The CLIF-C ACLFs is a clinically relevant, validated scoring system that can be used sequentially to stratify the risk of mortality in ACLF patients.Copyright © 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.

23 keywords...

hide…