Journal
JOURNAL OF HEPATOLOGY
Volume 62, Issue 4, Pages 831-840Publisher
ELSEVIER
DOI: 10.1016/j.jhep.2014.11.012
Keywords
Acute-on-chronic liver failure; Hepatic encephalopathy; Chronic liver failure
Categories
Funding
- Grifols
- comprehensive biomedical research center, UK
- INSERM-APHP
- Deutsche Forschungsgemeinschaft [SFB TRR57]
- Fondo de Investigacion Sanitaria Carlos III by FEDER [FIS_PI12/330]
- Novo Nordisk Fonden [NNF10OC1013267, NNF14OC0012141] Funding Source: researchfish
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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. Methods: 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. Results: 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). Conclusions: 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. (C) 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
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