Prospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 28, 2017; 23(28): 5237-5245
Published online Jul 28, 2017. doi: 10.3748/wjg.v23.i28.5237
Chronic liver failure-consortium acute-on-chronic liver failure and acute decompensation scores predict mortality in Brazilian cirrhotic patients
Rafael Veiga Picon, Franciele Sabadin Bertol, Cristiane Valle Tovo, Angelo Zambam de Mattos
Rafael Veiga Picon, Franciele Sabadin Bertol, Cristiane Valle Tovo, Gastroenterology and Hepatology Unit, Nossa Senhora da Conceição Hospital, Porto Alegre, Rio Grande do Sul 91350-200, Brazil
Cristiane Valle Tovo, Ângelo Zambam de Mattos, Gastroenterology and Hepatology Unit, Federal University of Health Sciences of Porto Alegre, Porto Alegre, Rio Grande do Sul 90050-170, Brazil
Ângelo Zambam de Mattos, Gastroenterology and Hepatology Unit, Pontifical Catholic University of Rio Grande do Sul, Porto Alegre, Rio Grande do Sul 90619-900, Brazil
Author contributions: Picon RV and Bertol FS contributed for acquisition of data; Picon RV, Bertol FS, Tovo CV and de Mattos ÂZ contributed to analysis and interpretation of data; Picon RV and de Mattos ÂZ drafted the manuscript; Tovo CV and de Mattos ÂZ contributed for the study concept and design; critical revision of the manuscript for important intellectual content; all authors approved the final version of the manuscript.
Institutional review board statement: The study was reviewed and approved by the Nossa Senhora da Conceição Hospital Institutional Review Board.
Conflict-of-interest statement: None.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ângelo Zambam de Mattos, MD, MSc, PhD, Professor of Medicine, Gastroenterology and Hepatology Unit, Federal University of Health Sciences of Porto Alegre, 154, Professor Annes Dias St., office 1103, Porto Alegre, Rio Grande do Sul 90050-170, Brazil. angmattos@hotmail.com
Telephone: +55-51-32269131 Fax: +55-51-32269131
Received: March 15, 2017
Peer-review started: March 18, 2017
First decision: May 12, 2017
Revised: May 30, 2017
Accepted: July 12, 2017
Article in press: July 12, 2017
Published online: July 28, 2017
Processing time: 135 Days and 0.6 Hours
Abstract
AIM

To validate prognostic scores for acute decompensation of cirrhosis and acute-on-chronic liver failure in Brazilian patients.

METHODS

This is a prospective cohort study designed to assess the prognostic performance of the chronic liver failure-consortium (CLIF-C) acute decompensation score (CLIF-C AD) and CLIF-C acute-on-chronic liver failure score (CLIF-C ACLF), regarding 28-d and 90-d mortality, as well as to compare them to other prognostic models, such as Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na), Child-Pugh (CP) score, and the CLIF-C Organ Failure score (CLIF-C OF). All participants were adults with acute decompensation of cirrhosis admitted to the Emergency Department of a tertiary hospital in southern Brazil. Prognostic performances were evaluated by means of the receiver operating characteristic (ROC) curves, area under the curves (AUC) and 95%CI.

RESULTS

One hundred and thirteen cirrhotic patients were included. At admission, 18 patients had acute-on-chronic liver failure (ACLF) and 95 individuals had acute decompensation (AD) without ACLF, of which 24 eventually developed ACLF during the course of hospitalization (AD evolving to ACLF group). The AD group had significantly lower 28-d (9.0%) and 90-d (18.3%) mortality as compared to the AD evolving to ACLF group and to the ACLF group (both P < 0.001). On the other hand, 28-d and 90-d mortalities were not significantly different between AD evolving to ACLF group and ACLF group (P = 0.542 and P = 0.708, respectively). Among patients with ACLF, at 28 d from the diagnosis, CLIF-C ACLF was the only score able to predict mortality significantly better than the reference line, with an AUC (95%CI) of 0.71 (95%CI: 0.54-0.88, P = 0.021). Among patients with AD, all prognostic scores performed significantly better than the reference line regarding 28-d mortality, presenting with similar AUCs: CLIF-C AD score 0.75 (95%CI: 0.63-0.88), CP score 0.72 (95%CI: 0.59-0.85), MELD score 0.75 (95%CI: 0.61-0.90), MELD-Na score 0.76 (95%CI: 0.61-0.90), and CLIF-C OF score 0.74 (95%CI: 0.60-0.88). The same occurred concerning AUCs for 90-d mortality: CLIF-C AD score 0.70 (95%CI: 0.57-0.82), CP score 0.73 (95%CI: 0.62-0.84), MELD score 0.71 (95%CI: 0.59-0.83), MELD-Na score 0.73 (95%CI: 0.62-0.84), and CLIF-C OF score 0.65 (95%CI: 0.52-0.78).

CONCLUSION

This study demonstrated that CLIF-C ACLF is the best available score for the prediction of 28-d mortality among patients with ACLF. CLIF-C AD score is also useful for the prediction of mortality among cirrhotic patients with AD not fulfilling diagnostic criteria for ACLF, but it was not superior to other well-established prognostic scores.

Keywords: Cirrhosis; Acute-on-chronic liver failure; Mortality; Prediction; Prognosis; Acute decompensation of cirrhosis

Core tip: The present study demonstrated that chronic liver failure-consortium (CLIF-C) acute-on-chronic liver failure score (ACLF) is the best available score for the prediction of 28-d mortality among patients with ACLF, but it was unable to determine the same regarding 90-d mortality. On the other hand, while this study also demonstrated that CLIF-C acute decompensation (AD) was useful for the prediction of 28-d and 90-d mortalities among patients with AD not fulfilling diagnostic criteria for ACLF, it failed to identify superiority when compared to other scores already routinely used worldwide.