Acute-on-chronic liver failure (ACLF) is associated with the rapid worsening of liver failure and high mortality. A well-validated scoring system used to predict survival and early intervention can improve outcomes. The challenge was to build a prognostic model in patients of ACLF by APASL’s definition that is better than existing MELD and CLIF-SOFA scores.

 

　　Ashok K Choudhury, MD, Institute of Liver and Biliary Sciences, New Delhi, India, representing the APASL ACLF Research Consortium (AARC), reported that based on his research from 1021 patients, the AARC-ACLF could be the answer.

 

　　The researchers enrolled a total 1021 ACLF cases with 90 days follow-up into the analysis, with a derivation set of 338 cases analyzed for a prognostic model and calibrated in 683 cases as a validation set.

 

　　The results demonstrated that of all the baseline independent predictors of mortality, total

 

　　bilirubin, creatinine, lactate, INR and hepatic encephalopathy were considered. AUROC in derivation and validation cohorts were 0.797and 0.793 respectively. AARC-ACLF score was developed with a minimum and maximum of 5 and 15. The score was better than the

 

　　MELD and CLIF-SOFA with an AUROC of 0.76, sensitivity of 70%, specificity of 67%, PPV of 78% and NPV of 58% in predicting 90 days survival. Grading was done with Grade A (5-9), Grade B (10-11) and Grade C (12-15 points). The mortality risk increases by 9.7% with each unit increase. Score of 11 at baseline or persistence of the same in the first week was associated with 100% mortality in 30 days. Overall, median survival was 26.3 days and for Grade B and C, 16 and 5 days respectively. Overall survival was 51.8%.

 

　　In short, he AARC-ACLF score is dynamic, simple and better than the existing models. Definitive therapies like transplant can be predicted within the first week, Dr. Choudhury concluded.