Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure
Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure
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DOI：
10.1016/j.jhep.2014.06.012
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发表时间：
2014-11-01
影响因子：
25.7
通讯作者：
Arroyo, Vicente
中科院分区：
文献类型：
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作者：
Jalan, Rajiv;Saliba, Faouzi;Arroyo, Vicente
背景和目的：慢性肝衰竭（ACLF）是一种常见综合征（患病率 30%），其特点是肝硬化急性失代偿、器官衰竭和高短期死亡率。本研究开发并验证了 ACLF 患者的特定预后评分。方法：使用 CANONIC 研究中纳入的 1349 名患者的数据。首先，开发了一个简化的器官功能评分系统（CLIF 联盟器官衰竭评分，CLIF-C OFs），用于使用所有患者的数据诊断 ACLF。随后，在 275 名 ACLF 患者中，将 CLIP-C OF 和另外两个独立的死亡率预测因子（年龄和白细胞计数）结合起来，制定了 ACLF 的特定预后评分（CLIF 联盟 ACLF 评分 [CLIF-C ACLFs]）。一致性指数（C-index）用于比较 CLIF-C ACLF、MELD、MELD-钠（MELD-Na）和 Child-Pugh（CPs）评分的辨别能力。 CLIF-C ACLF 在外部队列中进行了验证，并进行了序贯使用评估。 结果：CLIF-C ACLF 显示出比 MELD、MELD-Nas 和 CP 显着更高的预测准确性，在 CANONIC 和外部验证队列中，在 ACLF 诊断后的所有主要时间点（28、90、180 和 365 天），相应的预测误差率降低了 (19-28%)。 ACLF 诊断后 48 小时、3-7 天和 8-15 天计算的 CLIF-C ACLF 对 28 天死亡率的预测明显优于诊断时。结论：ACLF 诊断时的 CLIF-C ACLF 在预测死亡率方面优于 MELD 和 MELD-Na。 CLIP-C ACLF 是一种临床相关的、经过验证的评分系统，可连续用于对 ACLF 患者的死亡风险进行分层。 (C) 2014 年欧洲肝脏研究协会。由 Elsevier B.V. 出版。保留所有权利。
Background & Aims: Acute-on-chronic liver failure (ACLF) is a frequent syndrome (30% prevalence), characterized by acute decompensation of cirrhosis, organ failure(s) and high short-term mortality. This study develops and validates a specific prognostic score for ACLF patients.Methods: Data from 1349 patients included in the CANONIC study were used. First, a simplified organ function scoring system (CLIF Consortium Organ Failure score, CLIF-C OFs) was developed to diagnose ACLF using data from all patients. Subsequently, in 275 patients with ACLF, CLIP-C OFs and two other independent predictors of mortality (age and white blood cell count) were combined to develop a specific prognostic score for ACLF (CLIF Consortium ACLF score [CLIF-C ACLFs]). A concordance index (C-index) was used to compare the discrimination abilities of CLIF-C ACLF, MELD, MELD-sodium (MELD-Na), and Child-Pugh (CPs) scores. The CLIF-C ACLFs was validated in an external cohort and assessed for sequential use.Results: The CLIF-C ACLFs showed a significantly higher predictive accuracy than MELDs, MELD-Nas, and CPs, reducing (19-28%) the corresponding prediction error rates at all main time points after ACLF diagnosis (28, 90, 180, and 365 days) in both the CANONIC and the external validation cohort. CLIF-C ACLFs computed at 48 h, 3-7 days, and 8-15 days after ACLF diagnosis predicted the 28-day mortality significantly better than at diagnosis.Conclusions: The CLIF-C ACLFs at ACLF diagnosis is superior to the MELDs and MELD-Nas in predicting mortality. The CLIP-C ACLFs is a clinically relevant, validated scoring system that can be used sequentially to stratify the risk of mortality in ACLF patients. (C) 2014 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.