Predicting the immediate outcome in patients with acute on chronic liver disease by comparison of CLIF-C ACLF scores and MELD scores

Andrea Janice Fonseca; Rajendra Mane

doi:10.18203/2320-6012.ijrms20230166

Authors

Andrea Janice Fonseca Department of General Medicine, Dr. D. Y. Patil Medical College Hospital, and Research Institute Kolhapur, Maharashtra, India
Rajendra Mane Department of General Medicine, Dr. D. Y. Patil Medical College Hospital, and Research Institute Kolhapur, Maharashtra, India

DOI:

https://doi.org/10.18203/2320-6012.ijrms20230166

Keywords:

Acute on chronic liver disease, CLIF-C ACLF scores, MELD score

Abstract

Background: Acute on chronic liver disease is determined by the acute deterioration of liver function over a short period of time. It leads to an increase in morbidity and mortality, hence scores like model for end-stage liver disease (MELD) and chronic liver failure-sequential organ failure (CLIF-C ACLF) are identified to determine prognosis. A comparison would help us in determining which score is better for predicting immediate outcomes.

Methods: In this single centre study, patients of both genders, >18 years of age, >48 hours hospital stay with organ failure either ≤1, defined as, an increase in serum creatinine by 50% or more (1.5-fold from baseline), hepatic encephalopathy (HE) graded III/IV according to West haven criteria, liver failure, bilirubin ≥5 mg/dl, international normalized ratio (INR) ≥1.5 were enrolled after which relevant lab investigations and imaging was done and MELD and CLIF-C ACLF scores were applied, they were compared and analyzed.

Results: Among 50 patients, 62% had grade 2, 36% had grade 3 and only 1 had grade 4 HE. Mean MELD score and CLIF- C ACLF scores were significantly high in patients who expired (both p<0.05), and the mean PaO₂/FIO₂ratio was considerably low in patients with mortality (p=0.00). Sensitivity and specificity for CLIF-C ACLF score is much higher (90.9% and 100% respectively, with cut off value of 59), compared to the MELD score (77.3% and 60.7% respectively, with cut-off value of 25.50)

Conclusions: CLIF-C ACLF score is a better predictor of mortality and for survival in ACLF than the MELD score in changing the outcome of the patient.

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