![]() We concluded that a CLIF-C ACLF score ≥ 70 at 48 hours and organ failure are better predictors of mortality and that ICU care in these patients does not benefit them. Definitive therapy in the form of liver transplantation may have a promising role, if considered early.Īcute-on-chronic liver failure (ACLF) is a serious complication of hepatic cirrhosis, often requiring admission to ICU and organ support. Prognosis depends upon the number and severity of organ failures. Mortality was the primary outcome.Ĭomparison of both scores showed that a CLIF-C ACLF score ≥ 70 at 48 hours predicts mortality more accurately, with an area under receiver operating curve (AUROC) of 0.643 (confidence interval 95% 0.505-0.781 p=0.046) which was significantly higher than MELD scores of 30,40 and 50 at 48 hours. Organ failure and the need for supportive care were strong predictors of mortality (p= < 0.05). CLIF-C ACLF and MELD scores were calculated at admission and then at 24 and 48 hours after the ICU stay. Data were analyzed with the assistance of SPSS. The data of 75 patients admitted to the ICU of Shifa International Hospital in Islamabad were prospectively analyzed. There are many scores to assess prognosis in these patients, such as the Model for End-stage Liver Disease (MELD) score, the MELD score refined to take into account serum sodium level (MELD-Na), the chronic liver failure organ failure (CLIF-OF) score, the CLIF Consortium acute-on-chronic liver failure (CLIF-C ACLF) score and the Child-Turcotte-Pugh classification. This study was conducted to compare CLIF-C ACLF and MELD scores for selecting patients at risk of high mortality, as ICU care to these patients in the absence of liver transplantation may be of no value. The derivation and validation studies were trialed in patients admitted to a critical care unit therefore, its accuracy with regards to patients who are managed medically without a higher level care is not known.Acute-on-chronic liver failure (ACLF) is a serious complication of liver cirrhosis which presents with hepatic and/or extrahepatic organ failure and often needs admission to an Intensive Care Unit (ICU). This condition typically needs organ support and carries a high mortality rate. This study is not validated in or designed for use in patients with acute liver failure (for example, those with acetaminophen overdose or fulminant but de novo viral hepatitis) in the absence of pre-existing chronic liver disease. ![]() Common causes include sepsis, ongoing alcohol consumption, and relapse of viral hepatitis. In up to 50% of patients, the precipitating cause of ACLF remains unidentified. The first part of the score counts the number of failing organ systems the second part incorporates age and white cell count to calculate an ACLF score and a predicted mortality rate.Ī score of >65 is associated with 100% mortality 3-7 days after diagnosis of ACLF. Short term mortality in ACLF is high, around 25-75% at 28 days ( Moreau 2013). Decompensated liver disease is generally defined as the development of jaundice, ascites, encephalopathy, upper GI bleed, bacterial infection, or a combination of these, in a patient with existing cirrhotic liver disease.ĪCLF is a relatively new concept, characterized by a systemic inflammatory response as well as multiple organ failures (including decompensation of chronic liver disease).
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