Evaluation Of Scoring Systems For Predicting Short-term Mortality In Patients With Acute-on-chronic Liver Failure

Objective: To assess the predictive values of model for end-stage liver disease(MELD),MELD-sodium(MELD-Na),chronic liver failure-sequential organ failure assessment(CLIF-SOFA)and chronic liver failure consortium organ failure score(CLIF-C OFs),chronic liver failure consortium acute on chronic liver failure(CLIF-C ACLF),Chinese group on the study of severe hepatitis B-acute on chronic liver failure(COSSH-ACLF)for short-term mortality in patients with acute-on-chronic liver failure(ACLF)and find measure to predict short-term mortality more accurately.Methods: A total of 103 patients with ACLF were enrolled in this study between July 2013 and December 2018.Medical history,complications,therapy,parameters of physical and laboratory examinations during the golden window period were collected for calculation of MELD,MELD-Na,CLIF-SOFA,CLIF-C OF,CLIF-C ACLF and COSSH-ACLF scores,respectively.They were divided into groups(28-d survival group,28-d death group,90-d survival group,90-d death group)based on the prognosis in 28 days and 90 days.The predictive efficacy of scoring systems for short-term mortality in patients with ACLF was analyzed by receiver operating characteristic curve(ROC).Results:1.Among the 103 patients,62(60.19%)were dead within 28 days,69(66.9%)were dead within 90 days.Scores of MELD,MELD-Na,CLIF-SOFA,CLIF-C OF,CLIF-C ACLF and COSSH-ACLF were significantly higher in 28-d,90-d death group than those in 28-d,90-d survival group,respectively(P<0.05).2.The area under curve(AUC)values generated by the ROC curves of MELD,MELD-Na,CLIF-SOFA,CLIF-C OF,CLIF-C ACLF and COSSH-ACLF were 0.760(0.662-0.842),0.761(0.662-0.842),0.842(0.753-0.909),0.834(0.744-0.902),0.834(0.743-0.902),0.842(0.753-0.909)for predicting 28-d mortality,0.709(0.611-0.794),0.718(0.621-0.813),0.796(0.705-0.869),0.804(0.715-0.876),0.840(0.755-0.905),0.815(0.726-0.885)for predicting 90-d mortality,respectively.3.Multivariate analysis showed that age,blood platelet and CLIF-C ACLF were independent risk factors for 28-day prognosis in patients with ACLF.The predictive value is higher than CLIF-C ACLF when age,blood platelet and CLIF-C ACLF were combined(28-d mortality:AUC 0.879 vs 0.826;90-d mortality:AUC 0.885 vs 0.840).Conclusions: For patients with ACLF in China which HBV infection is the predominant cause of underlying chronic liver disease,the predictive value of CLIF-C ACLF for short-term mortality is higher than MELD?MELD-Na?CLIF SOFA?CLIF-C OF?COSSH-ACLF.The predictive value is higher than CLIF-C ACLF when age,blood platelet and CLIF-C ACLF were combined for that they are independent risk factors for short-term mortality in patients with ACLF.