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Assessment of scoring systems for acute-on-chronic liver failure at predicting short-term mortality in patients with alcoholic hepatitis
Authors:Hee Yeon Kim  Chang Wook Kim  Tae Yeob Kim  Do Seon Song  Dong Hyun Sinn  Eileen L Yoon  Young Kul Jung  Ki Tae Suk  Sang Soo Lee  Chang Hyeong Lee  Tae Hun Kim  Jeong Han Kim  Hyung Joon Yim  Sung Eun Kim  Soon Koo Baik  Byung Seok Lee  Jae Young Jang  Young Seok Kim  Sang Gyune Kim  Jin Mo Yang  Joo Hyun Sohn  Heon Ju Lee  Seung Ha Park  Eun Hee Choi  Dong Joon Kim  Korean Acute-on-Chronic Liver Failure Study Group
Abstract:
AIMTo assess the performance of proposed scores specific for acute-on-chronic liver failure in predicting short-term mortality among patients with alcoholic hepatitis.METHODSWe retrospectively collected data from 264 patients with clinically diagnosed alcoholic hepatitis from January to December 2013 at 21 academic hospitals in Korea. The performance for predicting short-term mortality was calculated for Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), CLIF Consortium Organ Failure score (CLIF-C OFs), Maddrey’s discriminant function (DF), age, bilirubin, international normalized ratio and creatinine score (ABIC), Glasgow Alcoholic Hepatitis Score (GAHS), model for end-stage liver disease (MELD), and MELD-Na.RESULTSOf 264 patients, 32 (12%) patients died within 28 d. The area under receiver operating characteristic curve of CLIF-SOFA, CLIF-C OFs, DF, ABIC, GAHS, MELD, and MELD-Na was 0.86 (0.81-0.90), 0.89 (0.84-0.92), 0.79 (0.74-0.84), 0.78 (0.72-0.83), 0.81 (0.76-0.86), 0.83 (0.78-0.88), and 0.83 (0.78-0.88), respectively, for 28-d mortality. The performance of CLIF-SOFA had no statistically significant differences for 28-d mortality. The performance of CLIF-C OFs was superior to that of DF, ABIC, and GAHS, while comparable to that of MELD and MELD-Na in predicting 28-d mortality. A CLIF-SOFA score of 8 had 78.1% sensitivity and 79.7% specificity, and CLIF-C OFs of 10 had 68.8% sensitivity and 91.4% specificity for predicting 28-d mortality.CONCLUSIONCLIF-SOFA and CLIF-C OF scores performed well, with comparable predictive ability for short-term mortality compared to the commonly used scoring systems in patients with alcoholic hepatitis.
Keywords:Acute-on-chronic liver failure   Alcoholic hepatitis   Mortality   Prognosis   Scoring system
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