Army Hospital Research and Referral dehradun, Uttarakhand, India
Manasvi Kalra, MBBS, MD1, Reshma Kaushik, MBBS, MD2, Ajay Shankar Prasad, MBBS, MD3, Priyank Dhiman, MBBS, MD4 1Army Hospital Research and Referral, Dehradun, Uttarakhand, India; 2Swami Rama Himalayan University, Dehradun, Uttarakhand, India; 3Army Hospital, Research and Referral, New Delhi, Delhi, India; 4Army Hospital Research and Referral, New Delhi, Delhi, India
Introduction: Various prognostic scores are used to predict the outcome of acute-on-chronic liver failure (ACLF). Data regarding their utility in predicting short-term mortality associated with ACLF are scarce in India. This prospective study compared the Chronic liver failure Consortium ACLF (CLIF-C ACLF), Model for end-stage liver disease–Sodium (MELD-Na), and Child-Turcotte-Pugh (CTP) scores as predictors of 28-day mortality among patients with ACLF.
Methods: CLIF-C ACLF, MELD-Na, and CTP scores were determined in 67 patients with ACLF at a tertiary healthcare center in India at the time of admission, and the concordance (C-) statistics of the three scores for 28-day mortality were assessed and compared
Results: High 28-day (59.7%) mortality was observed in patients with ACLF. A higher grade of ACLF corresponded to higher short-term mortality. The CLIF-C ACLF, MELD-Na, and CTP scores on day 1 were significantly higher among non-survivors than among survivors (p < 0.001 each). CLIF-C ACLF (C-statistic 0.99, p < 0.001), MELD-Na (C-statistic 0.943, p < 0.001), and CTP (C-statistic 0.918, p < 0.001) scores were good predictors of 28-day mortality in patients with ACLF. The CLIF-C ACLF score was better than the MELD-Na (p = 0.023) and CTP (p = 0.007) scores in predicting 28-day mortality while the MELD-Na and CTP scores were comparable in this regard.
Discussion: ACLF is associated with a very high short-term mortality rate. A higher grade of ACLF corresponded to a higher short-term mortality rate. CLIF-C ACLF, MELD-Na, and CTP scores were good predictors of short-term mortality in patients with ACLF. CLIF-C ACLF score was superior to MELD-Na and CTP scores in the prediction of short-term mortality in patients with ACLF while MELD-Na and CTP scores were comparable in this regard. As such, the CLIF-C ACLF score can be used to advantage in predicting the short-term outcome of ACLF
Figure: Comparison of the receiver operating characteristic curves for the predictive values of (a) CLIF-C ACLF and MELD-Na scores, (b) CLIF-C ACLF and CTP scores, and (c) MELD-Na and CTP scores for 28-day mortality.
Note: The table for this abstract can be viewed in the ePoster Gallery section of the ACG 2024 ePoster Site or in The American Journal of Gastroenterology's abstract supplement issue, both of which will be available starting October 27, 2024.
Disclosures:
Manasvi Kalra indicated no relevant financial relationships.
Reshma Kaushik indicated no relevant financial relationships.
Ajay Shankar Prasad indicated no relevant financial relationships.
Priyank Dhiman indicated no relevant financial relationships.
Manasvi Kalra, MBBS, MD1, Reshma Kaushik, MBBS, MD2, Ajay Shankar Prasad, MBBS, MD3, Priyank Dhiman, MBBS, MD4. P4584 - A Comparative Study of Prognostic Scores for Predicting 28-Day Mortality in Patients Having Acute on Chronic Liver Failure, ACG 2024 Annual Scientific Meeting Abstracts. Philadelphia, PA: American College of Gastroenterology.
