A single centre evaluation of the accuracy of an Acute-on-Chronic Liver Failure grading system in predicting mortality in cirrhotic patients admitted to the Mater hospital
F. Lynch, V. Cooper, E. McDermott, B. Kelleher, J.Leyden, P. MacMathuna, S. Stewart
Centre for Liver Disease, Mater Misericordiae University Hospital
Acute on Chronic Liver Failure (ACLF) is a term to define acute decompensation accompanied by organ failure in cirrhotic patients. Recently, a multi-centre prospective study of ACLF called CANONIC developed an ACLF grading (0-3) based on the severity of organ failure. This has helped define the syndrome and links to prognosis. It may also help stratify patients for early intervention (including ICU care) and have implications for resource allocation.
To investigate the role of the ACLF tool and to compare mortality rates to international rates.
We reviewed 118 admissions from the year 2014 with acute on chronic liver failure as identified by HIPE. 72 admissions in 47 patients met the CANONIC ACLF inclusion criteria. Using Patient Centre, the Mater’s electronic record, an ACLF score was assigned using the online calculator, http://www.clifconsortium.com/aclf-calculator. MELDNa scores were also calculated and ROC curves used for comparison.
There were 44 (61%) male patients and the average age was 47. The primary indications for admission were ascites (53%), encephalopathy (29%), haematemesis (21%) and sepsis (19%). The breakdown of ACLF grade was; 55 (76%) category 0, 0 (0%) category 1, 10 (14%) category 2 and 7 (10%) category 3. The 28-day mortality for each group was 5.5%, 30% and 57% respectively (p < 0.001), which is very similar to the CANONIC mortality of 5%, 32% and 77%. Our 1-year mortality was 20%, 50% and 86%. There was no difference between the ACLF and MELDNa scoring systems in prediction of mortality (p=0.06 for 28 days and 0.7 for 1 year).
The ACLF tool is a quick and simple scoring system, which accurately predicts mortality rates in acute on chronic liver failure. Our data validates the ACLF scoring system in an Irish healthcare setting and confirms that our short-term mortality for each severity category compares with that of international units. This clinical score can now be used to risk stratify patients in the emergency department and wards, while triaging liver consults or in guiding ICU care. Better treatments and preventions are required for those with high ACLF scores. Whether ACLF scoring confers additional benefit over MELDNa warrants further study.