Liver failure determines the outcome in patients of acute-on-chronic liver failure (ACLF): comparison of APASL ACLF research consortium (AARC) and CLIF-SOFA models

Choudhury A 1 , Jindal A 1 , Maiwall R 1 , Sharma MK 1 , Sharma BC 1 , Pamecha V 1 Show all authors , Mahtab M 2 , Rahman S 2 , Chawla YK 3 , Taneja S 3 , Tan SS 4 , Devarbhavi H 5 , Duan Z 6 , Yu C 6 , Ning Q 7 , Jia JD 8 , Amarapurkar D 9 , Eapen CE 10 , Goel A 10 , Hamid SS 11 , Butt AS 11 , Jafri W 11 , Kim DJ 12 , Ghazinian H 13 , Lee GH 14 , Sood A 15 , Lesmana LA 16 , Abbas Z 17 , Shiha G 18 , Payawal DA 19 , Dokmeci AK 20 , Sollano JD 21 , Carpio G 21 , Lau GK 22 , Karim F 23 , Rao PN 24 , Moreau R 25 , Jain P 1 , Bhatia P 1 , Kumar G 1 , Sarin SK 26 , APASL ACLF Working Party

Affiliations 

  • 1 Department of Hepatology and Transplant, Institute of Liver and Biliary Sciences (ILBS), New Delhi, 110 070, India
  • 2 Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
  • 3 Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
  • 4 Department of Gastroenterology and Hepatology, Selayang Hospital, Kepong, Malaysia
  • 5 Department of Gastroenterology and Hepatology, St John Medical College, Bangalore, India
  • 6 Beijing Youan Hospital, Capital Medical University, Beijing, China
  • 7 Department of Infectious Disease, Tongji Medical College, Tongji Hospital, Huazhong University of Science and Technology, Wuhan, China
  • 8 Liver Research Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
  • 9 Department of Gastroenterology and Hepatology, Bombay Hospital and Medical Research Centre, Mumbai, India
  • 10 Department of Gastrointestinal Sciences, Christian Medical College, Vellore, India
  • 11 Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
  • 12 Hallym University Chuncheon Sacred Heart Hospital, Center for Liver and Digestive Diseases, Chuncheon, Gangwon-Do, Republic of Korea
  • 13 Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia
  • 14 Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore
  • 15 Department of Gastroenterology, Dayanand Medical College, Ludhiana, India
  • 16 Division of Hepatology, University of Indonesia, Jakarta, Indonesia
  • 17 Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
  • 18 Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt
  • 19 Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines
  • 20 Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
  • 21 Cardinal Santos Medical Center, Metro Manila, Philippines
  • 22 The Institute of Translational Hepatology, Beijing, China
  • 23 Sir Salimur Rehman Medical College, Mitford Hospital, Dhaka, Bangladesh
  • 24 Asian Institute of Gastroenterology, Hyderabad, India
  • 25 Inserm, U1149, Centre de recherche sur l'Inflammation (CRI), UMR_S 1149, Labex INFLAMEX, Université Paris Diderot Paris 7, Paris, France
  • 26 Department of Hepatology and Transplant, Institute of Liver and Biliary Sciences (ILBS), New Delhi, 110 070, India. shivsarin@gmail.com
Hepatol Int, 2017 Sep;11(5):461-471.
PMID: 28856540 DOI: 10.1007/s12072-017-9816-z

Abstract

BACKGROUND AND AIMS: Acute-on-chronic liver failure (ACLF) is a progressive disease associated with rapid clinical worsening and high mortality. Early prediction of mortality and intervention can improve patient outcomes. We aimed to develop a dynamic prognostic model and compare it with the existing models.

METHODS: A total of 1402 ACLF patients, enrolled in the APASL-ACLF Research Consortium (AARC) with 90-day follow-up, were analyzed. An ACLF score was developed in a derivation cohort (n = 480) and was validated (n = 922).

RESULTS: The overall survival of ACLF patients at 28 days was 51.7%, with a median of 26.3 days. Five baseline variables, total bilirubin, creatinine, serum lactate, INR and hepatic encephalopathy, were found to be independent predictors of mortality, with AUROC in derivation and validation cohorts being 0.80 and 0.78, respectively. AARC-ACLF score (range 5-15) was found to be superior to MELD and CLIF SOFA scores in predicting mortality with an AUROC of 0.80. The point scores were categorized into grades of liver failure (Gr I: 5-7; II: 8-10; and III: 11-15 points) with 28-day cumulative mortalities of 12.7, 44.5 and 85.9%, respectively. The mortality risk could be dynamically calculated as, with each unit increase in AARC-ACLF score above 10, the risk increased by 20%. A score of ≥11 at baseline or persisting in the first week was often seen among nonsurvivors (p = 0.001).

CONCLUSIONS: The AARC-ACLF score is easy to use, dynamic and reliable, and superior to the existing prediction models. It can reliably predict the need for interventions, such as liver transplant, within the first week.

* Title and MeSH Headings from MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine.

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