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Hepatology International

, Volume 11, Issue 5, pp 461–471 | Cite as

Liver failure determines the outcome in patients of acute-on-chronic liver failure (ACLF): comparison of APASL ACLF research consortium (AARC) and CLIF-SOFA models

  • A. Choudhury
  • A. Jindal
  • R. Maiwall
  • M. K. Sharma
  • B. C. Sharma
  • V. Pamecha
  • M. Mahtab
  • S. Rahman
  • Y. K. Chawla
  • S. Taneja
  • S. S. Tan
  • H. Devarbhavi
  • Z. Duan
  • Chen Yu
  • Q. Ning
  • Ji Dong Jia
  • D. Amarapurkar
  • C. E. Eapen
  • A. Goel
  • S. S. Hamid
  • A. S. Butt
  • W. Jafri
  • D. J. Kim
  • H. Ghazinian
  • G. H. Lee
  • Ajit Sood
  • L. A. Lesmana
  • Z. Abbas
  • G. Shiha
  • D. A. Payawal
  • A. K. Dokmeci
  • J. D. Sollano
  • G. Carpio
  • G. K. Lau
  • F. Karim
  • P. N. Rao
  • R. Moreau
  • P. Jain
  • P. Bhatia
  • G. Kumar
  • S. K. SarinEmail author
  • APASL ACLF Working Party
Original Article

Abstract

Background and aims

Acute-on-chronic liver failure (ACLF) is a progressive disease associated with rapid clinical worsening and high mortality. Early prediction of mortality and intervention can improve patient outcomes. We aimed to develop a dynamic prognostic model and compare it with the existing models.

Methods

A total of 1402 ACLF patients, enrolled in the APASL-ACLF Research Consortium (AARC) with 90-day follow-up, were analyzed. An ACLF score was developed in a derivation cohort (n = 480) and was validated (n = 922).

Results

The overall survival of ACLF patients at 28 days was 51.7%, with a median of 26.3 days. Five baseline variables, total bilirubin, creatinine, serum lactate, INR and hepatic encephalopathy, were found to be independent predictors of mortality, with AUROC in derivation and validation cohorts being 0.80 and 0.78, respectively. AARC-ACLF score (range 5–15) was found to be superior to MELD and CLIF SOFA scores in predicting mortality with an AUROC of 0.80. The point scores were categorized into grades of liver failure (Gr I: 5–7; II: 8–10; and III: 11–15 points) with 28-day cumulative mortalities of 12.7, 44.5 and 85.9%, respectively. The mortality risk could be dynamically calculated as, with each unit increase in AARC-ACLF score above 10, the risk increased by 20%. A score of ≥11 at baseline or persisting in the first week was often seen among nonsurvivors (p = 0.001).

Conclusions

The AARC-ACLF score is easy to use, dynamic and reliable, and superior to the existing prediction models. It can reliably predict the need for interventions, such as liver transplant, within the first week.

Keywords

Cirrhosis ACLF AARC score Organ failure Liver failure 

Abbreviations

AARC

APASL ACLF research consortium

ACLF

Acute-on-chronic liver failure

HAV

Hepatitis A virus

HCC

Hepato-cellular carcinoma

HEV

Hepatitis E virus

HBV

Hepatitis B virus

SAH

Severe alcoholic hepatitis

TJLB

Trans-jugular liver biopsy

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

Approval of the institutional ethics committees was obtained.

Informed consent

Informed consent was taken from the patient or the next of kin.

Financial disclosures

None.

Supplementary material

12072_2017_9816_MOESM1_ESM.docx (137 kb)
Supplementary material 1 (DOCX 137 kb)
12072_2017_9816_MOESM2_ESM.tiff (1.5 mb)
Supplementary material 2 (TIFF 1521 kb)
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Supplementary material 3 (TIFF 1521 kb)
12072_2017_9816_MOESM4_ESM.docx (19 kb)
Supplementary material 4 (DOCX 19 kb)

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Copyright information

© Asian Pacific Association for the Study of the Liver 2017

Authors and Affiliations

  • A. Choudhury
    • 1
    • 26
  • A. Jindal
    • 1
    • 26
  • R. Maiwall
    • 1
    • 26
  • M. K. Sharma
    • 1
    • 26
  • B. C. Sharma
    • 1
    • 26
  • V. Pamecha
    • 1
  • M. Mahtab
    • 2
  • S. Rahman
    • 2
  • Y. K. Chawla
    • 3
  • S. Taneja
    • 3
  • S. S. Tan
    • 4
  • H. Devarbhavi
    • 5
  • Z. Duan
    • 6
  • Chen Yu
    • 6
  • Q. Ning
    • 7
  • Ji Dong Jia
    • 8
  • D. Amarapurkar
    • 9
  • C. E. Eapen
    • 10
  • A. Goel
    • 10
  • S. S. Hamid
    • 11
  • A. S. Butt
    • 11
  • W. Jafri
    • 11
  • D. J. Kim
    • 12
  • H. Ghazinian
    • 13
  • G. H. Lee
    • 14
  • Ajit Sood
    • 15
  • L. A. Lesmana
    • 16
  • Z. Abbas
    • 17
  • G. Shiha
    • 18
  • D. A. Payawal
    • 19
  • A. K. Dokmeci
    • 20
  • J. D. Sollano
    • 21
  • G. Carpio
    • 21
  • G. K. Lau
    • 22
  • F. Karim
    • 23
  • P. N. Rao
    • 24
  • R. Moreau
    • 25
  • P. Jain
    • 1
    • 26
  • P. Bhatia
    • 1
    • 27
  • G. Kumar
    • 1
    • 26
  • S. K. Sarin
    • 1
    • 26
    Email author
  • APASL ACLF Working Party
  1. 1.Department of Hepatology and TransplantInstitute of Liver and Biliary Sciences (ILBS)New DelhiIndia
  2. 2.Department of HepatologyBangabandhu Sheikh Mujib Medical UniversityDhakaBangladesh
  3. 3.Department of HepatologyPost Graduate Institute of Medical Education and ResearchChandigarhIndia
  4. 4.Department of Gastroenterology and HepatologySelayang HospitalKepongMalaysia
  5. 5.Department of Gastroenterology and HepatologySt John Medical CollegeBangaloreIndia
  6. 6.Beijing Youan HospitalCapital Medical UniversityBeijingChina
  7. 7.Department of Infectious Disease, Tongji Medical College, Tongji HospitalHuazhong University of Science and TechnologyWuhanChina
  8. 8.Liver Research Center, Beijing Friendship HospitalCapital Medical UniversityBeijingChina
  9. 9.Department of Gastroenterology and HepatologyBombay Hospital and Medical Research CentreMumbaiIndia
  10. 10.Department of Gastrointestinal SciencesChristian Medical CollegeVelloreIndia
  11. 11.Department of MedicineAga Khan University HospitalKarachiPakistan
  12. 12.Hallym University Chuncheon Sacred Heart HospitalCenter for Liver and Digestive DiseasesChuncheonRepublic of Korea
  13. 13.Department of HepatologyNork Clinical Hospital of Infectious DiseasesYerevanArmenia
  14. 14.Department of Gastroenterology and HepatologyNational University Health SystemSingaporeSingapore
  15. 15.Department of GastroenterologyDayanand Medical CollegeLudhianaIndia
  16. 16.Division of HepatologyUniversity of IndonesiaJakartaIndonesia
  17. 17.Department of HepatogastroenterologySindh Institute of Urology and TransplantationKarachiPakistan
  18. 18.Department of Internal MedicineEgyptian Liver Research Institute and HospitalCairoEgypt
  19. 19.Department of HepatologyCardinal Santos Medical CenterManilaPhilippines
  20. 20.Department of GastroenterologyAnkara University School of MedicineAnkaraTurkey
  21. 21.Cardinal Santos Medical CenterMetro ManilaPhilippines
  22. 22.The Institute of Translational HepatologyBeijingChina
  23. 23.Sir Salimur Rehman Medical CollegeMitford HospitalDhakaBangladesh
  24. 24.Asian Institute of GastroenterologyHyderabadIndia
  25. 25.Inserm, U1149, Centre de recherche sur l’Inflammation (CRI), UMR_S 1149, Labex INFLAMEX, Université Paris Diderot Paris 7ParisFrance
  26. 26.Department of HepatologyInstitute of Liver and Biliary Sciences (ILBS)New DelhiIndia
  27. 27.Department of Clinical ResearchInstitute of Liver and Biliary Sciences (ILBS)New DelhiIndia

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