摘要
AIM:To compare the utility of the Chronic Liver FailureSequential Organ Failure Assessment(CLIF-SOFA)and Asia-Pacific Association for the Study of Liver(APASL)definitions of acute-on-chronic liver failure(ACLF)in predicting short-term prognosis of patients with ACLF.METHODS:Consecutive patients of cirrhosis with acute decompensation were prospectively included.They were grouped into ACLF and no ACLF groups as per CLIF-SOFA and APASL criteria.Patients were followed up for 3 mo from inclusion or mortality whichever was earlier.Mortality at 28-d and 90-d was compared between no ACLF and ACLF groups as per both criteria.Mortality was also compared between different grades of ACLF as per CLIF-SOFA criteria.Prognostic scores like CLIF-SOFA,Acute Physiology and ChronicHealth Evaluation(APACHE)-Ⅱ,Child-Pugh and Model for End-Stage Liver Disease(MELD)scores were evaluated for their ability to predict 28-d mortality using area under receiver operating curves(AUROC).RESULTS:Of 50 patients,38 had ACLF as per CLIFSOFA and 19 as per APASL criteria.Males(86%)were predominant,alcoholic liver disease(68%)was the most common etiology of cirrhosis,sepsis(66%)was the most common cause of acute decompensation while infection(66%)was the most common precipitant of acute decompensation.The 28-d mortality in no ACLF and ACLF groups was 8.3%and 47.4%(P=0.018)as per CLIF-SOFA and 39%and 37%(P=0.895)as per APASL criteria.The 28-d mortality in patients with no ACLF(n=12),ACLF grade 1(n=11),ACLF grade 2(n=14)and ACLF grade 3(n=13)as per CLIF-SOFA criteria was 8.3%,18.2%,42.9%and76.9%(χ2 for trend,P=0.002)and 90-d mortality was 16.7%,27.3%,78.6%and 100%(χ2 for trend,P<0.0001)respectively.Patients with prior decompensation had similar 28-d and 90-d mortality(39.3%and 53.6%)as patients without prior decompensation(36.4%and 63.6%)(P=NS).AUROCs for 28-d mortality were 0.795,0.787,0.739 and 0.710 for CLIF-SOFA,APACHE-Ⅱ,Child-Pugh and MELD scores respectively.On multivariate analysis of these scores,CLIF-SOFA was the only significant independent predictor of mortality with an odds ratio 1.538(95%CI:1.078-2.194).CONCLUSION:CLIF-SOFA criteria is better than APASL criteria to classify patients into ACLF based on their prognosis.CLIF-SOFA score is the best predictor of short-term mortality.
AIM:To compare the utility of the Chronic Liver FailureSequential Organ Failure Assessment(CLIF-SOFA)and Asia-Pacific Association for the Study of Liver(APASL)definitions of acute-on-chronic liver failure(ACLF)in predicting short-term prognosis of patients with ACLF.METHODS:Consecutive patients of cirrhosis with acute decompensation were prospectively included.They were grouped into ACLF and no ACLF groups as per CLIF-SOFA and APASL criteria.Patients were followed up for 3 mo from inclusion or mortality whichever was earlier.Mortality at 28-d and 90-d was compared between no ACLF and ACLF groups as per both criteria.Mortality was also compared between different grades of ACLF as per CLIF-SOFA criteria.Prognostic scores like CLIF-SOFA,Acute Physiology and ChronicHealth Evaluation(APACHE)-Ⅱ,Child-Pugh and Model for End-Stage Liver Disease(MELD)scores were evaluated for their ability to predict 28-d mortality using area under receiver operating curves(AUROC).RESULTS:Of 50 patients,38 had ACLF as per CLIFSOFA and 19 as per APASL criteria.Males(86%)were predominant,alcoholic liver disease(68%)was the most common etiology of cirrhosis,sepsis(66%)was the most common cause of acute decompensation while infection(66%)was the most common precipitant of acute decompensation.The 28-d mortality in no ACLF and ACLF groups was 8.3%and 47.4%(P=0.018)as per CLIF-SOFA and 39%and 37%(P=0.895)as per APASL criteria.The 28-d mortality in patients with no ACLF(n=12),ACLF grade 1(n=11),ACLF grade 2(n=14)and ACLF grade 3(n=13)as per CLIF-SOFA criteria was 8.3%,18.2%,42.9%and76.9%(χ2 for trend,P=0.002)and 90-d mortality was 16.7%,27.3%,78.6%and 100%(χ2 for trend,P<0.0001)respectively.Patients with prior decompensation had similar 28-d and 90-d mortality(39.3%and 53.6%)as patients without prior decompensation(36.4%and 63.6%)(P=NS).AUROCs for 28-d mortality were 0.795,0.787,0.739 and 0.710 for CLIF-SOFA,APACHE-Ⅱ,Child-Pugh and MELD scores respectively.On multivariate analysis of these scores,CLIF-SOFA was the only significant independent predictor of mortality with an odds ratio 1.538(95%CI:1.078-2.194).CONCLUSION:CLIF-SOFA criteria is better than APASL criteria to classify patients into ACLF based on their prognosis.CLIF-SOFA score is the best predictor of short-term mortality.
引文
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