A novel prognostic model to predict mortality in patients with acute-chronic liver failure in intensive care unit

Abstract

Abstract Background Acute on chronic liver failure (ACLF) implies high short-term mortality rates and usually requires intensive care unit (ICU) admission. Proper prognosing these patients is crucial for early referral for liver transplantation. The superiority of CLIF-C ACLF score in Asian patients with ACLF admitted to an ICU remains inconclusive when compared to other scoring systems. The purpose of the study is (i) to compare the predictive performance of original MELD, MELD-Lactate, CLIF-C ACLF, CLIF-C ACLF-Lactate, and APACHE-II scores for short-term mortality assessment. (ii) to build and validate a novel scoring system and to compare its predictive performance to that of the original five scores. Methods 265 consecutive cirrhotic patients with ACLF who were admitted to our ICU were enrolled. The prognostic values for mortality were assessed by ROC analysis. A novel model was developed and internally validated using 5-fold cross-validation. Results Alcohol abuse was identified as the primary etiology of cirrhosis. The AUROC of the five prognostic scores in predicting one-month mortality prediction were not significantly superior to each other in predicting one-month and three-month mortality. The newly developed prognostic model, incorporating age, A-a gradient, BUN, total bilirubin level, INR, and HE grades, exhibited significantly improved performance in predicting one-month and three-month mortality with AUROC of 0.863 and 0.829, respectively, as compared to the original five prognostic scores. Conclusions The novel ACLF model is superior to the original five scores in predicting short-term mortality for ACLF patients admitted to an ICU. Further rigorous validation is required.