Retrospective Cohort Study
Copyright ©The Author(s) 2024.
World J Gastroenterol. May 28, 2024; 30(20): 2657-2676
Published online May 28, 2024. doi: 10.3748/wjg.v30.i20.2657
Table 1 Baseline characteristics of patients with Acute-on-chronic liver failure in different cohorts
Baseline characteristicsMIMIC cohort
External validation cohorts
Derivation set (n = 938)
Validation set (n = 313)
eICU (n = 551)
SHHMU (n = 121)
Age (yr)59 (52-68)56 (53-66)57 (50-64)58 ± 13
Male, n (%)617 (65.8)202 (64.5)334 (60.6)81 (66.9)
Race, n (%)
White613 (65.4)a209 (66.8)448 (81.3)Eastern Asian
Non white325 (34.6)a104 (33.2)103 (18.7)Eastern Asian
Etiology of cirrhosis, n (%)
Alcohol524 (55.9)b180 (57.5)376 (68.2)43 (35.5)
Non-alcohol414 (44.1)b133 (42.5)175 (31.8)78 (64.5)
AD at admission, n (%)
Ascites520 (55.4)a,b173 (55.3)169 (30.7)32 (26.4)
Hepatic encephalopathy390 (41.6)b136 (43.5)156 (28.3)31 (25.6)
Bacterial infection422 (45.0)b152 (48.6)216 (39.2)16 (13.2)
Acute variceal bleeding75 (8.0)a,b34 (10.9)127 (23.0)42 (34.7)
Laboratory indicators
WBC (109/L)12 (8-18)b13 (9-18)10 (6-14)6 (5-11)
Hemoglobin85 (73-100)b83 (72-98)88 (75-103)92 (77-107)
Platelet (109/L)81 (50-135)72 (49-120)78 (49-126)75 (48-116)
Total bilirubin (mg/dL)4.1 (1.6-11.7)4.9 (1.8-12.3)4.0 (1.5-12.9)6.2 (1.6-17.5)
Albumin (g/dL)2.9 (2.4-3.3)2.9 (2.4-3.4)2.8 (2.2-3.3)2.9 ± 0.6
ALT (U/L)39 (22-98)b39 (23-101)36 (21-97)34 (16-64)
AST (U/L)83 (44-216)b94 (47-266)91 (43-253)62 (35-138)
INR2.1 (1.6-2.8)a,b2.0 (1.6-2.7)1.7 (1.4-2.4)1.7 (1.2-2.6)
Prothrombin time (s)22 (17-30)b22 (17-29)21 (16-28)19 (14-29)
Serum creatinine (mg/dL)2.1 (1.3-3.4)2.0 (1.2-3.2)2.0 (1.1-3.2)2.1 (1.1-3.0)
Serum sodium (mEq/L)135 (131-139)135 (131-139)137 (133-142)134 ± 7
Serum potassium (mEq/L)4.6 (4.1-5.3)a,b4.6 (4.2-5.4)4.0 (3.6-4.6)4.2 (3.7-4.7)
Organ failure, n (%)
Circulatory failure382 (40.7)a,b148 (47.3)305 (55.4)18 (14.9)
Respiratory failure427 (45.5)a,b156 (49.8)162 (29.4)22 (18.2)
Cerebral failure129 (13.8)a,b46 (14.7)223 (40.5)38 (31.4)
Renal failure658 (70.1)a,b201 (64.2)280 (50.8)75 (62.0)
Coagulation failure332 (35.4)b106 (33.9)131 (23.8)37 (30.6)
Liver failure233 (24.8)a,b82 (26.2)273 (49.5)54 (44.6)
Prognostic scores at admission
MELD28 (22-34)a,b27 (21-34)25 ± 1025 (18-31)
MELD-Na31 (23-40)b31 (22-40)27 (19-35)30 (21-38)
CLIF-C ACLF58 (51-64)b58 (52-64)50 (45-57)47 (42-54)
Liver transplantation, n (%)44 (4.7)11 (3.5)24 (4.4)2 (1.7)
ACLF grade, n (%)
Grade 1266 (28.4)a86 (27.5)263 (46.3)30 (33.1)
Grade 2317 (33.8)105 (33.5)177 (31.1)50 (41.3)
Grade 3355 (37.8)a122 (39.0)128 (22.6)41 (33.9)
28-day mortality, n (%)376 (40.1)122 (39.0)--46 (38.0)
90-day mortality, n (%)465 (49.6)144 (46.0)--59 (48.7)
In-ICU mortality, n (%)----112 (20.3)--
In-hospital mortality, n (%)----179 (32.4)--
Table 2 Risk factors for 28-day mortality in acute-on-chronic liver failure patients from Medical Information Mart for Intensive Care-derivation set
VariableUnivariate analysis
Multivariate analysis
HR (95%CI)
P value
HR (95%CI)
P value
Female1.08 (0.88-1.33)0.47
Ln (age)2.18 (1.32-3.61)0.0029.14 (5.16-16.19)< 0.001
Race (Non-white)1.15 (0.93-1.41)0.20
Cirrhosis etiology (non-alcohol)1.00 (0.82-1.23)0.998
Ln (MAP)0.03 (0.01-0.06)< 0.0010.06 (0.03-0.14)< 0.001
Organ failures
Circulatory failure1.87 (1.53-2.29)< 0.001
Respiratory failure1.56 (1.27-1.93)< 0.0011.84 (1.48-2.29)< 0.001
Cerebral failure1.63 (1.26-2.11)< 0.0011.36 (1.05-1.77)0.02
Renal failure1.89 (1.53-2.34)< 0.0011.68 (1.36-2.09)< 0.001
Liver failure2.31 (1.67-2.50)< 0.001
Coagulation failure2.04 (1.87-2.84)< 0.001
Laboratory indicators
Ln (WBC)1.58 (1.33-1.88)< 0.0011.25 (1.05-2.10)0.01
Ln (hemoglobin)0.65 (0.44-0.97)0.04
Ln (platelet)0.84 (0.73-0.97)0.02
Ln (TB)1.50 (1.38-1.63)< 0.0011.57 (1.42-1.73)< 0.001
Ln (Albumin)0.68 (0.45-1.04)0.07
Ln (ALT)1.04 (0.97-1.12)0.29
Ln (AST)1.09 (1.02-1.17)0.01
Ln (INR)1.27 (1.20-1.33)< 0.0011.82 (1.43-2.32)< 0.001
Ln (sodium)0.04 (0.01-0.23)< 0.001
Ln (potassium)2.05 (1.23-3.41)0.0061.84 (1.10-3.07)0.02
Table 3 Predictive values of prognostic scores for 28-day mortality in patients with acute-on-chronic liver failure
Scores
Youden index
Cutoff value
SEN (%)
SPE (%)
PPV (%)
NPV (%)
Brier
score
R2 value
P in H-L test
Derivation set in MIMIC cohortDevelopment of MIMIC ACLF score
MIMIC ACLF0.480.5771.8175.9866.780.10.170.360.73
CLIF-C ACLF0.405965.4374.5663.276.30.190.260.70
MELD0.382773.1465.1258.478.40.200.200.04
MELD-Na0.36 2975.5359.9655.878.60.210.180.11
Validation set in MIMIC cohortInternal validation
MIMIC ACLF0.46 0.3281.9764.4069.584.80.170.360.26
CLIF-C ACLF0.406155.7484.2969.474.90.190.260.92
MELD0.37 2772.1364.4056.478.30.200.210.67
MELD-Na0.353072.9562.30 55.378.30.200.230.09
SHHMU cohort External validation
MIMIC ACLF0.49 1.5165.2284.0071.479.70.170.340.84
CLIF-C ACLF0.544971.7482.6771.782.7 0.170.350.14
MELD0.303336.9693.33 77.3 70.70.210.130.08
MELD-Na0.443460.8782.6768.377.50.200.220.52