![]() ![]() The cumulative mortality increases with rises in the AARC-ACLF score in the first week 10.ĭue to its rapidly changing nature, both initial characteristics and dynamic trends of clinical indicators are helpful to predict prognosis in ACLF 11. The ACLF guidelines proposed by the Asian Pacific Association for the Study of the Liver (APASL) 10 recommend that ACLF patients should be assessed with the APASL ACLF Research Consortium (AARC)-ACLF score on admission and dynamically evaluated on the 4th and 7th day of treatment to predict progression. Most of the patients would have a clear prognosis between day 3 and 7 of hospital admission and clinical decisions such as evaluation for liver transplant or discussion over goals of care could be tailored using clinical scores. 9 evaluated the clinical course by comparing the CLIF-C ACLF scores of patients at different time points, and found a close correlation between prognosis and changes in clinical condition. In recent years, research has focused on dynamic assessments that reflect more accurately the clinical condition and prognosis of ACLF. Examples are the classic Child–Turcotte–Pugh (CTP) and Model of End-stage Liver Disease (MELD) score 5, 6, or the more recent Chronic Liver Failure Sequential Organ Failure Assessment (CLIF-SOFA) and Chronic Liver Failure Consortium Acute-on-Chronic Liver Failure (CLIF-C ACLF) score proposed by the European Association for the Study of Chronic Liver Failure 7, 8. Early recognition of the poor prognosis in ACLF is not only helpful to minimize ineffective and expensive treatments, but also for rational allocation of liver transplantation resources 4.Īlthough a variety of scoring systems have been developed to assess prognosis in ACLF, most of them are based on clinical indicators at the time of diagnosis. Due to the high mortality rate, accurate prognosis prediction in ACLF has always been a hot topic in liver research. Additionally, ACLF is an extraordinarily dynamic syndrome that can either improve or even completely resolve in up to 50% of cases, while in others it may deteriorate to a life-threatening condition due to disease progression 3. It can be accompanied by multiple organ failures, and poses a major threat to public health 2. Prospective studies are needed to validate these results.Īcute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by acute decompensation of chronic liver disease, and often triggered by acute strikes or precipitating events 1. The new scoring model, which combined baseline characteristics and dynamic changes in clinical indicators to predict the course of ACLF, showed a better prognostic ability than current scoring systems. Comparative analysis showed that the AUC value for DP-ACLF was higher than for other prognostic scores, including Child–Turcotte–Pugh, MELD, MELD-Na, CLIF-SOFA, CLIF-C ACLF, and COSSH-ACLF. All prognostic scores were calculated based on the clinical data of patients at the third day, first week, and second week after admission, respectively, and were correlated with the 90-day prognosis by ROC analysis. Furthermore, a logistic prediction model (DP-ACLF) was constructed by combining the sum of dynamic trend scores and baseline prognostic parameters. We designed a dynamic trend score table based on the changing trends of these indicators. In the training set, multivariate Cox regression analysis revealed that age, WGO type, basic etiology, total bilirubin, creatinine, prothrombin activity, and hepatic encephalopathy stage were all independent prognostic factors in ACLF. ![]() The model’s performance was evaluated in a validation set of 130 patients from another center. To construct the model, we analyzed a training set of 541 patients from two hospitals. We conducted a retrospective cohort analysis of patients with ACLF from three different hospitals in China. Our aim was to build and validate a new scoring system to predict short-term prognosis using baseline and dynamic data in ACLF. Acute-on-chronic liver failure (ACLF) is a dynamic syndrome, and sequential assessments can reflect its prognosis more accurately.
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