Validation of prognostic scores predicting mortality in acute liver decompensation or acute-on-chronic liver failure: A Thailand multicenter study
1
Issued Date
2022-11-01
Resource Type
eISSN
19326203
Scopus ID
2-s2.0-85142918823
Pubmed ID
36413538
Journal Title
PLoS ONE
Volume
17
Issue
11 November
Rights Holder(s)
SCOPUS
Bibliographic Citation
PLoS ONE Vol.17 No.11 November (2022)
Suggested Citation
Teerasarntipan T., Thanapirom K., Chirapongsathorn S., Suttichaimongkol T., Chamroonkul N., Bunchorntavakul C., Siramolpiwat S., Chainuvati S., Sobhonslidsuk A., Leerapun A., Piratvisuth T., Sukeepaisarnjaroen W., Tanwandee T., Treeprasertsuk S. Validation of prognostic scores predicting mortality in acute liver decompensation or acute-on-chronic liver failure: A Thailand multicenter study. PLoS ONE Vol.17 No.11 November (2022). doi:10.1371/journal.pone.0277959 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/86455
Title
Validation of prognostic scores predicting mortality in acute liver decompensation or acute-on-chronic liver failure: A Thailand multicenter study
Author's Affiliation
Other Contributor(s)
Abstract
Background & objectives Cirrhosis patients with worsening of the liver function are defined as acute decompensation (AD) and those who develop extrahepatic organ failure are defined as acute-on-chronic liver failure (ACLF). Both AD and ACLF have an extremely poor prognosis. However, information regarding prognostic predictors is still lacking in Asian populations. We aimed to identify prognostic factors for 30-day and 90-day mortality in cirrhosis patients who develop AD with or without ACLF. Methods We included 9 tertiary hospitals from Thailand in a retrospective observational study enrolling hospitalized cirrhosis patients with AD. ACLF was diagnosed according to the EASL-CLIF criteria, which defined as AD patients who have kidney failure or a combination of at least two non-kidney organ failure. Outcomes were clinical parameters and prognostic scores associated with mortality evaluated at 30 days and 90 days. Results Between 2015 and 2020, 602 patients (301 for each group) were included. The 30-day and 90-day mortality rates of ACLF vs. AD were 57.48% vs. 25.50% (p<0.001) and 67.44% vs. 32.78% (p<0.001), respectively. For ACLF patients, logistic regression analysis adjusted for demographic data, and clinical information showed that increasing creatinine was a predictor for 30-day mortality (p = 0.038), while the CLIF-C OF score predicted both 30-day (p = 0.018) and 90-day (p = 0.037) mortalities, achieving the best discriminatory power with AUROCs of 0.705 and 0.709, respectively. For AD patients, none of the parameters was found to be significantly associated with 30-day mortality, while bacterial infection, CLIF-AD score and Child-Turcotte-Pugh score were independent parameters associated with 90-day mortality, with p values of 0.041, 0.024 and 0.024. However, their predictive performance became nonsignificant after adjustment by multivariate regression analysis. Conclusions Regarding Thai patients, the CLIF-C OF score was the best predictor for 30-day and 90-day mortalities in ACLF patients, while appropriate prognostic factors for AD patients remained inconclusive.