Assessing the Prediction Effect of Various Prognosis Model for 28-Day Mortality in Acute-on-Chronic Liver Failure Patients

Abstract

Background

Acute-on-chronic liver failure (ACLF) is an extremely clinical entity associated with short-term high mortality. The CLIF-SOFA score measures both hepatic and extrahepatic organ dysfunction and can discriminate significantly better between survivors and nonsurvivors compared to other methods. The MELD score is widely used for organ allocation in liver transplantation. Recent reports indicate that the PWR is a potential biomarker for predicting clinical outcomes. The ALBI score is a new score model for evaluating the severity of liver dysfunction. We aimed to compare these prognosis models to predict short-term mortality in ACLF patients.

Methods

A retrospective analysis of 89 ACLF patients between 2015 and 2018 was performed. The receiver operating characteristic (ROC) curve was used to assess the power of four prognosis models for predicting 28-day mortality in patients with ACLF.

Results

The ALBI score, MELD score and CLIF-SOFA score were significantly higher, and the PWR was slightly lower in nonsurviving ACLF patients than in surviving patients. The MELD score and ALBI score were positively correlated with the CLIF-SOFA score, while the PWR was inversely related to the CLIF-SOFA score. The area under the ROC curves (AUROCS) of the CLIF-SOFA score, PWR, ALBI score and MELD score were 0.804, 0.759, 0.710 and 0.670, respectively.

Conclusion

The CLIF-SOFA score, PWR and ALBI score can better predict 28-day mortality in ACLF patients, but the MELD score has worse predictability. The CLIF-SOFA score is the best prognosis model among these models. PWR may be a simple and useful tool that can predict 28-day outcome.

Keywords:

• CLIF-SOFA score
• platelet-to-white blood cell ratio
• albumin-bilirubin score
• acute-on-chronic liver failure
• prognosis

Acknowledgments

We would like to thanks the National Natural Science Foundation of China, the “Gan-Po Talent 555” Project of Jiangxi Province and the Postgraduate Innovation Special Foundation of Jiangxi Province for the economic support. LXL, YZ and YN are co-first authors in this manuscript and contributed equally to this study.

Ethical Approval

This study was approved by the Ethics Committee of The First Affiliated Hospital of Nanchang University (No.2015-1206). Written informed consent was obtained from all participants. This study was conducted in accordance with the Declaration of Helsinki.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors declare that there are no conflicts of interest.

Additional information

Funding

This study was supported by the National Natural Science Foundation of China (grant number: 81960120), “Gan-Po Talent 555” Project of Jiangxi Province (GCZ (2012)-1) and the Postgraduate Innovation Special Foundation of Jiangxi Province (YC2020-B046).