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

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Abstract

Acute-on-chronic liver failure (ACLF) implies high short-term mortality rates and usually requires intensive care unit (ICU) admission. Proper prognosis for 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. Two hundred sixty-five 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 fivefold cross-validation. Alcohol abuse was identified as the primary etiology of cirrhosis. The AUROC of the five prognostic scores were not significantly superior to each other in predicting 1-month and 3-month mortality. The newly developed prognostic model, incorporating age, alveolar–arterial gradient (A-a gradient), BUN, total bilirubin level, INR, and HE grades, exhibited significantly improved performance in predicting 1-month and 3-month mortality with AUROC of 0.863 and 0.829, respectively, as compared to the original five prognostic scores. The novel ACLF model seems to be superior to the original five scores in predicting short-term mortality in ACLF patients admitted to an ICU. Further rigorous validation is required.

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Acknowledgements

Thanks for all the medical staff who provided care to the patients included in this study.

Funding

This study was supported by grants from Chang Gung Medical Research Project (Chang Gung Memorial Hospital) (CMRPG3K0401-0402, CMRPG3M1931).

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, New Taipei Municipal TuCheng Hospital, Tucheng, New Taipei City, 236, Taiwan

    Shih-Hua Lin

  2. Division of Hepatology, Department of Gastroenterology and Hepatology, Linkou Chang-Gung Memorial Hospital, Taoyuan, 333, Taiwan

    Wei-Ting Chen, Ming-Hung Tsai, Li-Tong Liu, Wei-Liang Kuo, Yan-Ting Lin, Sheng-Fu Wang, Bo-Huan Chen, Cheng-Han Lee, Chien-Hao Huang & Rong-Nan Chien

  3. College of Medicine, Chang-Gung University, Taoyuan, 333, Taiwan

    Wei-Ting Chen, Ming-Hung Tsai, Chien-Hao Huang & Rong-Nan Chien

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  1. Shih-Hua Lin
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Contributions

CHH and SHL designed the study, analyzed the results, and drafted the manuscript. WTC, MHT, WLK, YTL, SFW, and CHL contributed to the clinical portions of the study, including caring patients, data collection and literature review. CHH, LTL, and BHC designed and executed the data analysis plan. RNC supervised and provided comments on the study. All authors have read and approved the final manuscript.

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Correspondence to Chien-Hao Huang.

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The authors declare that they have no competing interests.

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The Institutional Review Board of Linkou Chang Gung Memorial Hospital approved the study (202000112B0).

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Lin, SH., Chen, WT., Tsai, MH. et al. A novel prognostic model to predict mortality in patients with acute-on-chronic liver failure in intensive care unit. Intern Emerg Med 19, 721–730 (2024). https://doi.org/10.1007/s11739-024-03536-4

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