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The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure

2014; Elsevier BV; Volume: 62; Issue: 4 Linguagem: Inglês

10.1016/j.jhep.2014.11.012

1600-0641

Rajiv Jalan, Marco Pavesi, Faouzi Saliba, Àlex Amorós, Javier Fernández, Peter Holland‐Fischer, Rohit Sawhney, Rajeshwar P. Mookerjee, Paolo Caraceni, Richard Moreau, Pere Ginés, François Durand, Paolo Angeli, Carlo Alessandria, Wim Laleman, Jonel Trebicka, Didier Samuel, Stefan Zeuzem, Thierry Gustot, Alexander L. Gerbes, Julia Wendon, Mauro Bernardi, Vicente Arroyo,

Drug-Induced Hepatotoxicity and Protection

Background & Aims Cirrhotic patients with acute decompensation frequently develop acute-on-chronic liver failure (ACLF), which is associated with high mortality rates. Recently, a specific score for these patients has been developed using the CANONIC study database. The aims of this study were to develop and validate the CLIF-C AD score, a specific prognostic score for hospitalised cirrhotic patients with acute decompensation (AD), but without ACLF, and to compare this with the Child-Pugh, MELD, and MELD-Na scores. Methods The derivation set included 1016 CANONIC study patients without ACLF. Proportional hazards models considering liver transplantation as a competing risk were used to identify score parameters. Estimated coefficients were used as relative weights to compute the CLIF-C ADs. External validation was performed in 225 cirrhotic AD patients. CLIF-C ADs was also tested for sequential use. Results Age, serum sodium, white-cell count, creatinine and INR were selected as the best predictors of mortality. The C-index for prediction of mortality was better for CLIF-C ADs compared with Child-Pugh, MELD, and MELD-Nas at predicting 3- and 12-month mortality in the derivation, internal validation and the external dataset. CLIF-C ADs improved in its ability to predict 3-month mortality using data from days 2, 3–7, and 8–15 (C-index: 0.72, 0.75, and 0.77 respectively). Conclusions The new CLIF-C ADs is more accurate than other liver scores in predicting prognosis in hospitalised cirrhotic patients without ACLF. CLIF-C ADs therefore may be used to identify a high-risk cohort for intensive management and a low-risk group that may be discharged early.