Chronic Liver Failure-Sequential Organ Failure Assessment is better than the Asia-Pacific Association for the Study of Liver criteria for defining acute-on-chronic liver failure and predicting outcome

Table 1 Characteristics of study population

Characteristics	n = 50
Age (yr)	46 ± 131
Male gender	43 (86)2
Cause of cirrhosis
Alcohol	29 (58)
Hepatitis C virus + alcohol	5 (10)
Autoimmune	3 (6)
Hepatitis B virus	3 (6)
Wilson	3 (6)
Cryptogenic	7 (14)
Acute precipitating event
Sepsis	33 (66)
Active alcoholism	20 (40)
Autoimmune flare	2 (4)
Hepatitis B virus flare	2 (4)
Upper gastrointestinal bleed	2 (4)
Acute hepatitis E virus infection	1 (2)
Cytomegalovirus infection	1 (2)
Unknown	4 (8)
More than one cause	15 (30)
Type of acute decompensation
Sepsis	33 (66)
Ascites	8 (16)
Hepatic encephalopathy	17 (34)
Upper gastrointestinal bleed	5 (10)
More than one decompensation	13 (26)
Prior decompensation	28 (56)
Bilirubin (mg/dL)	13.2 (0.6-43.0)3
Total leukocyte count (/mm3)	10100 (2700-39000)
Platelet count (103/mm3)	90.0 (14.4-444.0)
International normalized ratio	2.5 ± 0.8
Serum creatinine (mg/dL)	1.6 (0.5-7.9)
Jaundice	45 (90)
Ascites	42 (84)
Hepatic encephalopathy	17 (34)
Upper gastrointestinal bleed	6 (12)
Organ failures
Liver	29 (58)
Kidney	22 (44)
Cerebral	5 (10)
Coagulation	23 (46)
Respiratory	2 (4)
Circulation	2 (4)
≥ 2 organ failures	14 (28)
Prognostic scores
Child-Pugh score	11.4 ± 1.7
MELD score	29.2 ± 7.8
APACHE II score	13.0 (4.0-41.0)
CLIF-SOFA score	9.9 ± 2.7
Mortality
28-d mortality	19 (38)
90-d mortality	29 (58)

¹mean ± SD;

²Number (percentage);

³Median (range). APACHE: Acute Physiology and Chronic Health Evaluation; CLIF-SOFA: Chronic Liver Failure-Sequential Organ Failure Assessment; MELD: Model for End-Stage Liver Disease.

Table 2 Comparison of patients with and without acute-on-chronic liver failure as per Chronic Liver Failure-Sequential Organ Failure Assessment and Asia-Pacific Association for the Study of Liver definitions

Characteristics	CLIF-SOFA criteria			APASL criteria
	No ACLF (n = 12)	ACLF (n = 38)	P value	No ACLF (n = 31)	ACLF (n = 19)	P value
Age (yr)	53 ± 161	44 ± 12	0.048	50 ± 12	41 ± 14	0.02
	52 (26-78)3	44 (22-70)		48 (34-78)	37 (22-70)
Male gender	11 (92)2	32 (84)	1.000	29 (94)	14 (33)	0.089
Bilirubin (mg/dL)	9.6 (2.1-30.6)	15.5 (0.6-43.0)	0.195	10.7 (0.6-43.0)	18.0 (5.0-32.6)	0.029
Total leukocyte count (/mm3)	9450 (4500-21500)	10100 (2700-39000)	1.000	9300 (3600-36400)	11300 (2700-39000)	0.460
Platelet count (103/mm3)	85.5 (14.4-151.0)	91.5 (14.8-444.0)	0.525	72.0 (14.4-444.0)	110.0 (14.8-382.0)	0.276
International normalized ratio	1.8 ± 0.3	2.7 ± 0.8	< 0.001	2.2 ± 0.6	2.9 ± 0.9	0.005
Serum creatinine (mg/dL)	1.0 (0.6-1.9)	2.1 (0.5-7.9)	0.002	2.1 (0.5-7.9)	1.5 (0.5-3.3)	0.112
Jaundice	11 (92)	34 (90)	1.000	26 (84)	19 (100)	0.142
Ascites	8 (67)	34 (90)	0.082	23 (74)	19 (100)	0.018
Hepatic encephalopathy	3 (25)	14 (37)	0.510	13 (42)	4 (21)	0.218
Acute gastrointestinal bleed	2 (17)	4 (11)	0.621	5 (16)	1 (5)	0.387
Organ failures
Liver	4 (33)	25 (66)	0.091	14 (45)	15 (79)	0.037
Kidney	0 (0)	22 (58)	< 0.001	16 (52)	6 (32)	0.166
Cerebral	0 (0)	5 (13)	0.319	4 (13)	1 (5)	0.637
Coagulation	0 (0)	23 (61)	< 0.001	11 (36)	12 (63)	0.057
Respiratory	0 (0)	2 (5)	1.000	2 (7)	0 (0)	0.519
Circulation	1 (8)	1 (3)	0.426	2 (7)	0 (0)	0.519
Prognostic scores
Child-Pugh score	10.3 ± 1.6	11.7 ± 1.6	0.014	11.0 ± 1.9	12.0 ± 1.3	0.045
MELD score	21.8 ± 5.6	31.6 ± 6.9	< 0.001	28.5 ± 8.3	30.4 ± 6.9	0.408
APACHE-II score	9.5 (4.0-21.0)	14.0 (6.0-41.0)	0.019	12.0 (4-41)	14.0 (4-22)	0.508
CLIF-SOFA score	7.7 ± 2.3	10.6 ± 2.5	0.002	9.6 ± 2.7	10.3 ± 2.7	0.356
Mortality
28-d mortality	1 (8.3)	18 (47.4)	0.018	12 (38.7)	7 (36.8)	0.895
90-d mortality	2 (16.7)	27 (71.1)	0.002	16 (51.6)	13 (68.4)	0.242

¹mean ± SD;

²Number (percentage);

³Median (range). ACLF: Acute-on-Chronic Liver Failure; APACHE: Acute Physiology and Chronic Health Evaluation; APASL: Asia-Pacific Association for the Study of Liver; CLIF-SOFA: Chronic Liver Failure-Sequential Organ Failure Assessment; MELD: Model for End-stage Liver Disease.

Table 3 Comparison of survivors and non-survivors at 28 d

Characteristics	28-d mortality
	Yes (n = 19)	No (n = 31)	P value
Age (yr)	45 ± 121	47 ± 14	0.649
Male gender	16 (84)2	27 (87)	1.000
Prior decompensation	11 (57.9)	17 (54.8)	0.833
Bilirubin (mg/dL)	17.7 (1.2-37.6)3	10.7 (0.6-43.0)	0.139
Total leukocyte count (/mm3)	11200 (2700-39000)	9300 (3600-36400)	0.873
Platelet count (103/mm3)	81.0 (14.8-382.0)	90.0 (14.4-444.0)	0.734
International normalized ratio	2.7 ± 0.7	2.3 ± 0.8	0.054
Serum creatinine (mg/dL)	2.2 (0.5-7.9)	1.6 (0.6-6.3)	0.509
Jaundice	18 (95)	27 (87)	0.637
Ascites	17 (90)	25 (81)	0.693
Hepatic encephalopathy	10 (53)	7 (23)	0.037
Upper gastrointestinal bleed	1 (5)	5 (16)	0.387
Organ failures
Liver	14 (74)	15 (48)	0.139
Kidney	12 (63)	10 (32)	0.033
Cerebral	5 (26)	0 (0)	0.005
Coagulation	12 (63)	11 (36)	0.057
Respiratory	0 (0)	2 (11)	0.140
Circulation	1 (5)	1 (5)	1.000
Prognostic scores
Child-Pugh score	12.3 ± 1.3	10.8 ± 1.7	0.002
MELD score	32.8 ± 7.1	27.1 ± 7.5	0.010
APACHE II score	15.0 (8-41)	10.0 (4.0-25.0)	0.001
CLIF-SOFA score	11.6 ± 2.5	8.8 ± 2.3	< 0.001

¹mean ± SD;

²Number (percentage);

³Median (range). ACLF: Acute-on-Chronic Liver Failure; APACHE: Acute Physiology and Chronic Health Evaluation; APASL: Asia-Pacific Association for the Study of Liver; CLIF-SOFA: Chronic Liver Failure-Sequential Organ Failure Assessment; MELD: Model for End-stage Liver Disease.