Hepatic encephalopathy (HE) is a serious condition with high mortality rates. The outcomes of HE in patients admitted to the intensive care unit (ICU) are predicted using numerous scoring systems, among which are Child-Turcotte-Pugh (CTP), Model for End-stage Liver Disease (MELD), Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II) as the most popular. While these scores have been evaluated in HE associated with acute liver failure (type A), this study attempted to examine the prognostic value of these scores in patients with HE on a background of liver cirrhosis (type C), utilizing 200 cirrhotic patients hospitalized with HE. West Haven criteria determined the diagnosis and classification of HE. All patients within the first 24 hours after admission underwent APACHE II, CLIF-SOFA, MELD, MELD-sodium (MELD-Na) and CTP scores calculation; and then based on survival outcomes, they were categorized into either improved or deceased. Both deceased and improved groups saw a comparison between Demographic, clinical, and laboratory data as well as prognostic scores were recorded. The receiver operating characteristic (ROC) curve was plotted, and the area under the ROC curve (AUROC) was estimated for each score. Backward logistic regression analysis was also utilized.Males comprised 60.5% of the enrolled patients, with a mean age of 61.09 ± 8.94 years. 

Infections like spontaneous bacterial peritonitis (54.0%) followed by variceal bleeding (19.5%) were the main precipitating factors of HE. Deceased patients had significantly higher scores (all types).AUROC were 0.734, 0.717, 0.663, 0.626, and 0.609 for CLIF-SOFA, MELD-Na, MELD, APACHE II, and CTP scores, respectively. MELD, MELD-Na, and CLIF-SOFA scores independently predicted mortality, with CLIF-SOFA being the strongest independent predictor of mortality.

Thus, the CLIF-SOFA score was regarded to be superior to other prognostic scores in predicting mortality in hospitalized patients with HE type C.

Source: Abbasy M, et al. Egypt Liver J. 2022;12(13) . https://doi.org/10.1186/s43066-022-00178-z