Jacqueline G O'Leary1,2, K Rajender Reddy3, Guadalupe Garcia-Tsao4, Scott W Biggins5, Florence Wong6, Michael B Fallon7, Ram M Subramanian8, Patrick S Kamath9, Paul Thuluvath10, Hugo E Vargas11, Benedict Maliakkal12, Puneeta Tandon13, Jennifer Lai14, Leroy R Thacker15, Jasmohan S Bajaj15. 1. Dallas VA Medical Center, Dallas, TX. 2. Baylor University Medical Center, Dallas, TX. 3. University of Pennsylvania, Philadelphia, PA. 4. Yale University, New Haven, CT. 5. University of Colorado, Denver, CO. 6. University of Toronto, Toronto, ON, Canada. 7. University of Texas, Houston, TX. 8. Emory University, Atlanta, GA. 9. Mayo Clinic, Rochester, MN. 10. Mercy Medical Center, Baltimore, MD. 11. Mayo Clinic, Scottsdale, AZ. 12. University of Rochester, Rochester, NY. 13. University of Alberta, Edmonton, AB, Canada. 14. University of California, San Francisco, San Francisco, CA. 15. Virginia Commonwealth University and McGuire VA Medical Center, Richmond, VA.
Abstract
The North American Consortium for the Study of End-Stage Liver Disease's definition of acute-on-chronic liver failure (NACSELD-ACLF) as two or more extrahepatic organ failures has been proposed as a simple bedside tool to assess the risk of mortality in hospitalized patients with cirrhosis. We validated the NACSELD-ACLF's ability to predict 30-day survival (defined as in-hospital death or hospice discharge) in a separate multicenter prospectively enrolled cohort of both infected and uninfected hospitalized patients with cirrhosis. We used the NACSELD database of 14 tertiary care hepatology centers that prospectively enrolled nonelective hospitalized patients with cirrhosis (n = 2,675). The cohort was randomly split 60%/40% into training (n = 1,605) and testing (n = 1,070) groups. Organ failures assessed were (1) shock, (2) hepatic encephalopathy (grade III/IV), (3) renal (need for dialysis), and (4) respiratory (mechanical ventilation). Patients were most commonly Caucasian (79%) men (62%) with a mean age of 57 years and a diagnosis of alcohol-induced cirrhosis (45%), and 1,079 patients had an infection during hospitalization. The mean Model for End-Stage Liver Disease score was 19, and the median Child score was 10. No demographic differences were present between the two split groups. Multivariable modeling revealed that the NACSELD-ACLF score, as determined by number of organ failures, was the strongest predictor of decreased survival after controlling for admission age, white blood cell count, serum albumin, Model for End-Stage Liver Disease score, and presence of infection. The c-statistics were 0.8073 for the training set and 0.8532 for the validation set. CONCLUSION: Although infection status remains an important predictor of death, NACSELD-ACLF was independently validated in a separate large multinational prospective cohort as a simple, reliable bedside tool to predict 30-day survival in both infected and uninfected patients hospitalized with a diagnosis of cirrhosis. (Hepatology 2018;67:2367-2374).
The North American Consortium for the Study of End-Stage Liver Disease's definition of acute-on-chronic liver failure (NACSELD-ACLF) as two or more extrahepatic organ failures has been proposed as a simple bedside tool to assess the risk of mortality in hospitalized patients with cirrhosis. We validated the NACSELD-ACLF's ability to predict 30-day survival (defined as in-hospital death or hospice discharge) in a separate multicenter prospectively enrolled cohort of both infected and uninfected hospitalized patients with cirrhosis. We used the NACSELD database of 14 tertiary care hepatology centers that prospectively enrolled nonelective hospitalized patients with cirrhosis (n = 2,675). The cohort was randomly split 60%/40% into training (n = 1,605) and testing (n = 1,070) groups. Organ failures assessed were (1) shock, (2) hepatic encephalopathy (grade III/IV), (3) renal (need for dialysis), and (4) respiratory (mechanical ventilation). Patients were most commonly Caucasian (79%) men (62%) with a mean age of 57 years and a diagnosis of alcohol-induced cirrhosis (45%), and 1,079 patients had an infection during hospitalization. The mean Model for End-Stage Liver Disease score was 19, and the median Child score was 10. No demographic differences were present between the two split groups. Multivariable modeling revealed that the NACSELD-ACLF score, as determined by number of organ failures, was the strongest predictor of decreased survival after controlling for admission age, white blood cell count, serum albumin, Model for End-Stage Liver Disease score, and presence of infection. The c-statistics were 0.8073 for the training set and 0.8532 for the validation set. CONCLUSION: Although infection status remains an important predictor of death, NACSELD-ACLF was independently validated in a separate large multinational prospective cohort as a simple, reliable bedside tool to predict 30-day survival in both infected and uninfected patients hospitalized with a diagnosis of cirrhosis. (Hepatology 2018;67:2367-2374).
Authors: Jasmohan S Bajaj; Jacqueline G OʼLeary; Puneeta Tandon; Florence Wong; Guadalupe Garcia-Tsao; Patrick S Kamath; Scott W Biggins; Jennifer C Lai; Hugo E Vargas; Benedict Maliakkal; Michael B Fallon; Paul J Thuluvath; Ram M Subramanian; Leroy R Thacker; K Rajender Reddy Journal: Am J Gastroenterol Date: 2019-07 Impact factor: 10.864
Authors: Jasmohan S Bajaj; Jacqueline G O'Leary; Puneeta Tandon; Florence Wong; Patrick S Kamath; Scott W Biggins; Guadalupe Garcia-Tsao; Jennifer Lai; Michael B Fallon; Paul J Thuluvath; Hugo E Vargas; Benedict Maliakkal; Ram M Subramanian; Leroy R Thacker; K Rajender Reddy Journal: Aliment Pharmacol Ther Date: 2019-04-29 Impact factor: 8.171
Authors: Nadim Mahmud; Zachary Fricker; Marina Serper; David E Kaplan; Kenneth D Rothstein; David S Goldberg Journal: Liver Int Date: 2019-06-17 Impact factor: 5.828
Authors: Hani Shamseddeen; Kavish R Patidar; Marwan Ghabril; Archita P Desai; Lauren Nephew; Sandra Kuehl; Naga Chalasani; Eric S Orman Journal: Am J Med Date: 2020-05-29 Impact factor: 4.965
Authors: Jessica B Rubin; Yanin T Srisengfa; Somaya Albhaisi; Chathur Acharya; Gayatri Nangia; Tahira Shaikh; Leroy R Thacker; K Rajender Reddy; Puneeta Tandon; Jasmohan S Bajaj; Jennifer C Lai Journal: Clin Gastroenterol Hepatol Date: 2019-10-05 Impact factor: 11.382
Authors: Karen Y Xiao; Rebecca A Hubbard; David E Kaplan; Tamar H Taddei; David S Goldberg; Nadim Mahmud Journal: Hepatol Int Date: 2020-06-09 Impact factor: 6.047