The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure
Rajiv Jalan, Marco Pavesi, Faouzi Saliba, Alex Amorós, Javier Fernandez, Peter Holland-Fischer, Rohit Sawhney, Rajeshwar Mookerjee, Paolo Caraceni, Richard Moreau, Pere Ginès, Francois Durand, Paolo Angeli, Carlo Alessandria, Wim Laleman, Jonel Trebicka, Didier Samuel, Stefan Zeuzem, Thierry Gustot, Alexander L Gerbes, Julia Wendon, Mauro Bernardi, Vicente Arroyo, CANONIC Study Investigators; EASL-CLIF Consortium, Patricia Aguilar Melero, Agustin Albillos, Rafael Bañares, Daniel Benten, Massimo Bocci, Paolo Caraceni, María-Vega Catalina, Jun Liong Chin, Minneke J Coenraad, Mar Concepción, Audrey Coilly, Livia Dorn, Carme Deulofeu, Laure Elkrief, Javier Fernandez, Elisabet Garcia, Angelo Gatta, Ludmila Gerber, Andrea de Gottardi, Isabel Graupera, Henning Grøenbæk, AnneKristin Hausen, Corinna Hopf, Stine Karlsen, Ansgar W Lohse, Caterina Maggioli, Daniel Markwardt, Javier Martinez, Alfredo Marzano, Manuel de la Mata García, P Aiden McCormick, Francisco Mesonero, José Luis Montero Álvarez, Rajeshwar P Mookerjee, Filippo Morando, Christophe Moreno, Bernhard Morrell, Christian Mortensen, Frederik Nevens, Markus Peck-Radosavljevic, Gustavo Pereira, Alessandro Risso, Mario Rizzetto, Antonietta Romano, Didier Samuel, Tilman Sauerbruch, Macarena Simon-Talero, Elsa Solà-Vergés, Pablo Solis-Muñoz, German Soriano, Jan Sperl, Walter Spindelboeck, Rudolf Stauber, Christian Steib, Dominique Valla, Len Verbeke, Hans Van Vlierberghe, Wolfgang Vogel, Henninge Wege, Tania Welzel, Chris Willars, Maria Yago Baenas, Giacomo Zaccherini, Rajiv Jalan, Marco Pavesi, Faouzi Saliba, Alex Amorós, Javier Fernandez, Peter Holland-Fischer, Rohit Sawhney, Rajeshwar Mookerjee, Paolo Caraceni, Richard Moreau, Pere Ginès, Francois Durand, Paolo Angeli, Carlo Alessandria, Wim Laleman, Jonel Trebicka, Didier Samuel, Stefan Zeuzem, Thierry Gustot, Alexander L Gerbes, Julia Wendon, Mauro Bernardi, Vicente Arroyo, CANONIC Study Investigators; EASL-CLIF Consortium, Patricia Aguilar Melero, Agustin Albillos, Rafael Bañares, Daniel Benten, Massimo Bocci, Paolo Caraceni, María-Vega Catalina, Jun Liong Chin, Minneke J Coenraad, Mar Concepción, Audrey Coilly, Livia Dorn, Carme Deulofeu, Laure Elkrief, Javier Fernandez, Elisabet Garcia, Angelo Gatta, Ludmila Gerber, Andrea de Gottardi, Isabel Graupera, Henning Grøenbæk, AnneKristin Hausen, Corinna Hopf, Stine Karlsen, Ansgar W Lohse, Caterina Maggioli, Daniel Markwardt, Javier Martinez, Alfredo Marzano, Manuel de la Mata García, P Aiden McCormick, Francisco Mesonero, José Luis Montero Álvarez, Rajeshwar P Mookerjee, Filippo Morando, Christophe Moreno, Bernhard Morrell, Christian Mortensen, Frederik Nevens, Markus Peck-Radosavljevic, Gustavo Pereira, Alessandro Risso, Mario Rizzetto, Antonietta Romano, Didier Samuel, Tilman Sauerbruch, Macarena Simon-Talero, Elsa Solà-Vergés, Pablo Solis-Muñoz, German Soriano, Jan Sperl, Walter Spindelboeck, Rudolf Stauber, Christian Steib, Dominique Valla, Len Verbeke, Hans Van Vlierberghe, Wolfgang Vogel, Henninge Wege, Tania Welzel, Chris Willars, Maria Yago Baenas, Giacomo Zaccherini
Abstract
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.
Keywords: Acute-on-chronic liver failure; Chronic liver failure; Hepatic encephalopathy.
Copyright © 2015 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
Source: PubMed