Federal University of Health Sciences of Porto Alegre, Graduate Program in Medicine: Hepatology, Porto Alegre, Brazil; Mãe de Deus Hospital, Gastroenterology and Hepatology Unit, Porto Alegre, Brazil.
Mãe de Deus Hospital, Gastroenterology and Hepatology Unit, Porto Alegre, Brazil.
Ann Hepatol. 2019 Mar-Apr;18(2):373-378. doi: 10.1016/j.aohep.2019.01.001. Epub 2019 Apr 15.
Different criteria are applied for the diagnosis of acute-on-chronic liver failure (ACLF). Our aim was to compare the performance of different ACLF diagnostic criteria for predicting mortality.
This was a prospective cohort study of adult cirrhotic patients admitted to a tertiary hospital for acute decompensation (AD) of cirrhosis. The evaluated outcome was mortality at 28 and 90 days, according to the different ACLF diagnostic criteria: Chronic Liver Failure Consortium (CLIF-C), Asian Pacific Association for the Study of the Liver-ACLF Research Consortium (AARC) and North American Consortium for the Study of End-Stage Liver Disease (NACSELD). Prognostic performance was evaluated using receiver operating characteristic (ROC) curves.
146 patients were included. 43 (29.5%) with ACLF according to CLIF-C definition, 14 (9.6%) with ACLF by AARC definition, and 6 (4.1%) by NACSELD definition. According to Kaplan-Meier survival analyses median survival of patients with ACLF by CLIF-C definition was 27.0 days, median survival of patients with ACLF by AARC definition was 27.0 days, and median survival of patients with ACLF by NACSELD definition was 4.0 days. The areas under the ROC curves for performance evaluation in predicting mortality at 28 days for CLIF-C, AARC and NACSELD criteria were, respectively, 0.710, 0.560 and 0.561 (p=0.002). Regarding 90-day mortality, the areas under the ROC curves were 0.760, 0.554 and 0.555 respectively (p<0.001).
ACLF definition proposed by CLIF-C had better performance in predicting mortality at 28 and 90 days when compared to criteria proposed by AARC and NACSELD.
不同的标准适用于急性慢性肝衰竭（ACLF）的诊断。我们的目的是比较不同 ACLF 诊断标准预测死亡率的性能。
这是一项前瞻性队列研究，纳入了因肝硬化急性失代偿（AD）而入住三级医院的成年肝硬化患者。评估的结局是根据不同的 ACLF 诊断标准（慢性肝衰竭联盟[CLIF-C]、亚太肝病学会 ACLF 研究联盟[AARC]和北美终末期肝病研究联盟[NACSELD]）在 28 天和 90 天的死亡率。使用接收者操作特征（ROC）曲线评估预后性能。
共纳入 146 例患者。根据 CLIF-C 定义，43 例（29.5%）为 ACLF；根据 AARC 定义，14 例（9.6%）为 ACLF；根据 NACSELD 定义，6 例（4.1%）为 ACLF。根据 Kaplan-Meier 生存分析，CLIF-C 定义的 ACLF 患者中位生存时间为 27.0 天，AARC 定义的 ACLF 患者中位生存时间为 27.0 天，NACSELD 定义的 ACLF 患者中位生存时间为 4.0 天。CLIF-C、AARC 和 NACSELD 标准预测 28 天死亡率的 ROC 曲线下面积分别为 0.710、0.560 和 0.561（p=0.002）。关于 90 天死亡率，ROC 曲线下面积分别为 0.760、0.554 和 0.555（p<0.001）。
与 AARC 和 NACSELD 标准相比，CLIF-C 提出的 ACLF 定义在预测 28 天和 90 天死亡率方面具有更好的性能。
