Rajiv Jalan1, Marco Pavesi2, Faouzi Saliba3, Alex Amorós2, Javier Fernandez4, Peter Holland-Fischer1, Rohit Sawhney1, Rajeshwar Mookerjee1, Paolo Caraceni5, Richard Moreau6, Pere Ginès7, Francois Durand3, Paolo Angeli8, Carlo Alessandria9, Wim Laleman10, Jonel Trebicka11, Didier Samuel3, Stefan Zeuzem12, Thierry Gustot13, Alexander L Gerbes14, Julia Wendon15, Mauro Bernardi16, Vicente Arroyo16. 1. Liver Failure Group, Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom. 2. Data Management Center, EASL-CLIF Consortium, Barcelona, Spain. 3. Hôpital Paul Brousse, Villejuif, France. 4. Hospital Clínic, University of Barcelona, IDIBAPS, CIBEReHD, IRSIN, Spain. 5. Policlinico St Orsola Malpighi, Bologna, Italy. 6. Hopital Beaujon, Clichy, France. 7. Hospital Clínic, University of Barcelona, IDIBAPS, CIBEReHD, IRSIN, Spain. Electronic address: PGINES@clinic.ub.es. 8. University of Padua, Padova, Italy. 9. University of Turin, Torino, Italy. 10. University Hospital Gasthuisberg, Leuven, Belgium. 11. University Hospital Bonn, Bonn, Germany. 12. J.W Goethe University Hospital, Frankfurt, Germany. 13. Erasme Hospital Brussels, Brussels, Belgium. 14. University of Munich, Klinikum der LMU, Munich, Germany. 15. King's College Hospital, London, United Kingdom. 16. EASL-CLIF Consortium, Barcelona, Spain.
Abstract
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.
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 ADpatients. 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.
Authors: M Müller; J C Schefold; A B Leichtle; D Srivastava; G Lindner; A K Exadaktylos; C A Pfortmueller Journal: Med Klin Intensivmed Notfmed Date: 2018-08-21 Impact factor: 0.840
Authors: Sara Blasco-Algora; José Masegosa-Ataz; María Luisa Gutiérrez-García; Sonia Alonso-López; Conrado M Fernández-Rodríguez Journal: World J Gastroenterol Date: 2015-11-14 Impact factor: 5.742
Authors: A Choudhury; A Jindal; R Maiwall; M K Sharma; B C Sharma; V Pamecha; M Mahtab; S Rahman; Y K Chawla; S Taneja; S S Tan; H Devarbhavi; Z Duan; Chen Yu; Q Ning; Ji Dong Jia; D Amarapurkar; C E Eapen; A Goel; S S Hamid; A S Butt; W Jafri; D J Kim; H Ghazinian; G H Lee; Ajit Sood; L A Lesmana; Z Abbas; G Shiha; D A Payawal; A K Dokmeci; J D Sollano; G Carpio; G K Lau; F Karim; P N Rao; R Moreau; P Jain; P Bhatia; G Kumar; S K Sarin Journal: Hepatol Int Date: 2017-08-30 Impact factor: 6.047