Validation of the CLIF-C OF Score and CLIF-C ACLF Score to Predict Transplant-Free Survival in Patients with Liver Cirrhosis and Concomitant Need for Intensive Care Unit Treatment
Abstract
:1. Introduction
2. Material and Methods
2.1. Patients
2.2. Definition of ACLF
2.3. Follow-Up
2.4. Ethics
2.5. Statistical Analysis
3. Results
3.1. Patient Characteristics
3.2. Predictors of 28-Days Mortality
3.3. Predictors for Long-Term (90-Days and 365-Days) Mortality
3.4. Survival Analysis in ACLF Grade 3 According to CLIF-C ACLFs
4. Discussion
5. Declaration
Availability of Supporting Data
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
Abbreviations
References
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Variable | All Patients | Deceased within 28 Days | Alive after 28 Days | p-Value | |
---|---|---|---|---|---|
N | 136 | 75 | 61 | ||
Age (years) (IQR) | 60 (51; 67) | 59 (51; 66) | 61 (52; 69) | 0.255 | |
Male gender, n (%) | 90 (66%) | 46 (61%) | 44 (72%) | 0.186 | |
Etiology | alcohol, n (%) viral hepatitis, n (%) NAFLD, n (%) others, n (%) | 89 (65%) 11 (8%) 10 (7%) 17 (13%) | 51 (68%) 7 (9%) 6 (8%) 11 (15%) | 47 (77%) 4 (7%) 4 (7%) 6 (15%) | 0.855 |
reason for decompensation of liver cirrhosis and ICU admission | Bleeding, n (%) Infection, n (%) after surgical procedure, n (%) Others, n (%) | 41 (30%) 27 (20%) 18 (13%) 50 (37%) | 20 (27%) 9 (12%) 14 (19%) 32 (42%) | 14 (23%) 13 (21%) 6 (10%) 28 (46%) | 0.873 |
ACLF at admission, n (%)
| 19 (14%) 18 (13%) 34 (25%) 65 (48%) | 6 (8%) 10 (13%) 17 (23%) 42 (56%) | 13 (21%) 9 (15%) 17 (28%) 23 (38%) | 0.072 | |
MELD (IQR) | 28 (20; 36) | 33 (27; 36) | 21 (16; 28) | <0.001 | |
Infection at ICU admission, n (%) | 38 (28%) | 21 (28%) | 17 (28%) | 0.975 | |
Renal replacement therapy during ICU treatment, n (%) | 78 (57%) | 58 (77%) | 20 (33%) | <0.001 | |
Mechanical ventilation during ICU treatment, n (%) | 75 (55%) | 50 (67%) | 25 (41%) | <0.003 | |
Vasopressor therapy during ICU treatment, n (%) | 117 (86%) | 69 (92%) | 48 (79%) | <0.026 | |
CLIF-C OF score (IQR) CLIF-C ACLF score (IQR) | 11 (9; 13) 56 (51; 66) | 12 (10; 14) 61 (53; 71) | 10 (8; 12) 53 (49; 58) | <0.001 <0.001 | |
Bilirubin (mg/dL) (IQR) | 4 (1.6; 9.9) | 6.7 (2.6; 19.6) | 2.2 (1.1; 4.8) | <0.001 | |
Sodium (mmol/L)(IQR) | 136 (131; 141) | 137 (131; 140) | 136 (131; 141) | 0.613 | |
Platelets (/nL) (IQR) | 94 (53; 165) | 88 (51; 144) | 114 (67; 177) | 0.035 | |
INR (IQR) | 1.6 (1.3; 2.1) | 1.9 (1.5; 2.2) | 1.3 (1.2; 1.8) | <0.001 | |
Creatinine (mg/dL) (IQR) | 2.1 (1.3; 3.2) | 2.4 (1.4; 3.3) | 1.9 (1.1; 3.0) | 0.167 | |
WBC (/nL) (IQR) | 10 (7; 15.4) | 11.7 (8.3; 17) | 9 (5.8; 15) | 0.051 | |
CRP (mg/L) (IQR) | 29 (12; 71) | 41 (16; 105) | 19 (8; 43) | 0.005 |
28-Days Mortality AUROC (95% CI) | AUROC (90-Days Mortality) | AUROC (365-Days Mortality) | |
---|---|---|---|
CLIF_C OF score (total cohort) | 0.687 (0.599–0.774) | 0.713 (0.613–0.812) | 0.689 (0.581–0.796) |
CLIF-C OF score (patients with ACLF) | 0.652 (0.554–0.750) | 0.666 (0.551–0.781) | 0.678 (0.552–0.804) |
CLIF-C ACLF score (patients with ACLF) | 0.717 (0.626–0.809) | 0.710 (0.598–0.821) | 0.675 (0.550–0.800) |
AD score (patients without ACLF) | 0.792 (0.560–1.000) | 0.713 (0.527–0.899) | 0.653 (0.425–0.880) |
MELD score (total cohort) | 0.795 (0.719–0.870) | 0.837 (0.756–0.918) | 0.756 (0.655–0.857) |
MELD score (patients with ACLF) | 0.767 (0.680–0.854) | 0.844 (0.758–0.931) | 0.784 (0.679–0.890) |
MELD score (patients without ACLF) | 0.851 (0.657–1.000) | 0.722 (0.480–0.965) | 0.494 (0.222–0.766) |
Sensitivity | Specificity | Positive Predictive Value (PPV) | Negative Predictive Value (NPV) | |
---|---|---|---|---|
CLIF-C ACLF score *
| 25.7 38.6 54.3 | 97.8 87.2 85.1 | 94.7 81.8 84.4 | 6.9 48.8 55.6 |
CLIF-C OF score
| 19.7 34.2 39.5 | 96.7 95.1 86.9 | 88.2 89.7 78.9 | 49.2 53.7 53.5 |
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Nagel, M.; Westphal, R.; Hilscher, M.; Galle, P.R.; Schattenberg, J.M.; Schreiner, O.; Labenz, C.; Wörns, M.A. Validation of the CLIF-C OF Score and CLIF-C ACLF Score to Predict Transplant-Free Survival in Patients with Liver Cirrhosis and Concomitant Need for Intensive Care Unit Treatment. Medicina 2023, 59, 866. https://doi.org/10.3390/medicina59050866
Nagel M, Westphal R, Hilscher M, Galle PR, Schattenberg JM, Schreiner O, Labenz C, Wörns MA. Validation of the CLIF-C OF Score and CLIF-C ACLF Score to Predict Transplant-Free Survival in Patients with Liver Cirrhosis and Concomitant Need for Intensive Care Unit Treatment. Medicina. 2023; 59(5):866. https://doi.org/10.3390/medicina59050866
Chicago/Turabian StyleNagel, Michael, Ruben Westphal, Max Hilscher, Peter R. Galle, Jörn M. Schattenberg, Oliver Schreiner, Christian Labenz, and Marcus Alexander Wörns. 2023. "Validation of the CLIF-C OF Score and CLIF-C ACLF Score to Predict Transplant-Free Survival in Patients with Liver Cirrhosis and Concomitant Need for Intensive Care Unit Treatment" Medicina 59, no. 5: 866. https://doi.org/10.3390/medicina59050866