Acute-on-chronic liver failure (ACLF) is a specific syndrome associated with high short-term mortality. Early identification of patients at high risk is crucial in determining emergency for transplantation and deciding and prioritizing the need for intensive care unit (ICU). A recent study evaluated the performance of the different prognostic scores in the prediction of in-hospital mortality in patients with ACLF. 249 patients with ACLF were enrolled for the study and followed till discharge from the hospital. Univariate and Cox regression analyses assessed the performance of liver-specific (Child-Pugh and MELD) and ACLF prognostic scores (CLIF-C OF, CLIF-SOFA, CLIF-C AD, CLIF-C ACLF) in the prediction of in-hospital mortality.

The observations were as follows-

• 71.1% of the patients were males with a mean age of 53.9 ± 12.8 years. 
• 57.8% of the patient demonstrated HCV as the etiology of pre-existing liver disease. 
• Sepsis was found to be the commonest precipitating factor (49.8%) and the mortality rate was found to be 74.3%. 
• Univariate analysis found all scores to be significantly higher in the deceased group. 
• AUROC were found to be 0.897, 0.884, 0.870, 0.861, 0.861, and 0.850 for CLIF-C OF, CLIF-C AD, CLIF-C ACLF, Child-Pugh, CLIF-SOFA, and MELD scores, respectively. 
• Multivariate analysis found 2 independent predictors of mortality - CLIF-C ACLF score and Child-Pugh class C.

All the studied scores could predict in-hospital mortality of patients with ACLF. However, CLIF-C ACLF and Child-Pugh class performed better as they could significantly and independently predict mortality.

SOURCE- Zakareya T, Akl M, Shibl S. et al. Utility of prognostic scores in predicting short-term mortality in patients with acute-on-chronic liver failure. Egypt Liver Journal 2022; 12. https://doi.org/10.1186/s43066-022-00183-2