However, the acceptance of cirrhotic patients in ICU has been hampered by their high mortality, high costs per admission, and scarcity of ICU beds (5-7). ACLF justifies most admissions of cirrhotic patients to intensive care units (ICU) (5). Recently, two new scores were developed and validated in ACLF patients admitted to tertiary centers: a diagnostic score (Chronic Liver Failure Consortium - Organ Failure ) and a prognostic score (Chronic Liver Failure Consortium - Acute-on-Chronic Liver Failure ) (4). For the diagnosis of organ failure, the CLIF-SOFA score (Chronic Liver Failure - Sequential Organ Failure Assessment) has been used (3). It is characterized by acute decompensation of cirrhosis, organ failure and high short-term mortality. Acute-on-chronic liver failure (ACLF) is an evidence-based defined syndrome which is highly prevalent (3). Liver cirrhosis affects 0.1% of the European population and will be the 11 th leading cause of death in 2030 (1,2). Key words: Acute-on-chronic liver failure. The new CLIF scores identify high mortality cirrhotic patients admitted to the ward and are better than their predecessors to predict ACLF patients' short/medium term mortality. The CLIF-C ACLF score was significantly superior to CTP, MELD, MELD-Na in predicting 28-day (AUROC 0.799 ± 0.078, 95% CI 0.637-0.891) and 90-day mortality (AUROC 0.828 ± 0.063, 95% CI 0.705-0.952).Ĭonclusion: ACLF is highly prevalent in the ward. ACLF 28 and 90-day mortality was 45.8% and 60.4%, respectively. Infection (p < 0.001) and hepatic encephalopathy (p = 0.004) were more prevalent and C-reactive protein and leukocyte counts were higher in ACLF patients. ACLF grade 1 was diagnosed in 55.1% of the ACLF patients grade 2, in 42.8%, and grade 3, in 2.0%. At admission, 19.8% of patients presented ACLF and 7.9% developed it during hospitalization (overall prevalence was 27.7%). Alcohol was the cirrhosis cause/co-factor in 79.7% of cases. Methods: Retrospective cohort study of 177 patients admitted to the Gastroenterology ward for acute decompensation of cirrhosis. The aims of the present study are: a) comparing the Chronic Liver Failure Consortium (CLIF-C) ACLF Model for End-Stage Liver Disease (MELD), MELD Sodium (MELD-Na) and Child-Turcotte-Pugh (CTP) scores for prediction of short/medium term mortality b) identifying ACLF prevalence in patients admitted to the ward and c) comparing mortality between non-ACLF/ACLF. All authors approved the submitted manuscript.īackground and aims: Acute-on-chronic liver failure (ACLF) is a frequent syndrome associated with high mortality. MP and GN collaborated in the data collection and critical review of the manuscript. LRR, CF, JF and JF interpreted the data and critically reviewed the manuscript for important intellectual content. Almada, PortugalĮthics statement: This study was approved by local health research ethics boards (Garcia de Orta Ethical Committee, Garcia de Orta Centre) and the requirement for individual informed consent was waived.Īuthors contributions: RB designed the study, acquired the data and drafted the manuscript. Rita Barosa, Lídia Roque-Ramos, Marta Patita, Gonçalo Nunes and Jorge Fonsecaĭepartment of Gastroenterology. CLIF-C ACLF score is a better mortality predictor than MELD, MELD-Na and CTP in patients with acute on chronic liver failure admitted to the ward
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