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.
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).
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).
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.
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APASL ACLF research consortium
Acute-on-chronic liver failure
Hepatitis A virus
Hepatitis E virus
Hepatitis B virus
Severe alcoholic hepatitis
Trans-jugular liver biopsy
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Conflict of interest
The authors declare that they have no conflict of interest.
Approval of the institutional ethics committees was obtained.
Informed consent was taken from the patient or the next of kin.
The study was approved by institute ethical committee vide letter no F/25/5/64/AC2013/912 and the respective centers also had their own ethical board approval for the study to be carried out. The centers, investigators and the number of patients contibuted are listed as follows:
|Center no.||Name||Country/center||Total patients|
|1||Dr. Shiv K Sarin||ILBS, India||1286|
|5||Dr. Mamun-Al Mahtab||Bangladesh||145|
|6||Dr. Yogesh Chawala||Chandigarh||128|
|9||Dr. Tan SS||Malaysia||109|
|3||Dr. Harshad Devarbhavi||Bangalore||103|
|2||Dr. Zhongping Duan||Beijing||98|
|21||Dr. Qin Ning, Jidong Jia,||China||96|
|14||Dr. Deepak Naryan||Bombay Hospital||76|
|8||Dr. Saeed Hamid||Karachi, Pakistan||69|
|22||Dr. Kim et.al.||Republic of Korea||68|
|10||Dr. Guan Huei Lee||Singapore||39|
|7||Dr. Ajit sood||Ludhiana, India||34|
|12||Dr. Laurentius A. Lesmana||Indonesia||28|
|17||Dr. Zaigham Abbas||Pakistan||25|
|23||Dr. Gamal Shiha||Egypt||25|
|11||Dr. Diana Alcantara-Payawal||Philippines||21|
|20||Dr. A. Kadir Dokmeci||Turkey||19|
|24||Dr. Man-Fung Yuen||Hong Kong||12|
|15||Dr. George K Lau||China||10|
|18||Dr. Fazal Karim||Bangladesh||6|
|19||Dr. P N Rao||Hyderabad, India||4|
|Complete data for analysis||1402|
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Cite this article
Choudhury, A., Jindal, A., Maiwall, R. et al. 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. Hepatol Int 11, 461–471 (2017). https://doi.org/10.1007/s12072-017-9816-z
- AARC score
- Organ failure
- Liver failure