Risk Management and Healthcare Policy (Dec 2020)
Assessing the Prediction Effect of Various Prognosis Model for 28-Day Mortality in Acute-on-Chronic Liver Failure Patients
Abstract
Lin Xiang Liu,* Yue Zhang,* Yuan Nie,* Xuan Zhu Department of Gastroenterology, The First Affiliated Hospital of Nanchang University, Nanchang 330006, People’s Republic of China*These authors contributed equally to this workCorrespondence: Xuan ZhuDepartment of Gastroenterology, The First Affiliated Hospital of Nanchang University, No. 17, Yongwaizhengjie Road, Donghu District, Nanchang 330006, Jiangxi, People’s Republic of ChinaEmail [email protected]: Acute-on-chronic liver failure (ACLF) is an extremely clinical entity associated with short-term high mortality. The CLIF-SOFA score measures both hepatic and extrahepatic organ dysfunction and can discriminate significantly better between survivors and nonsurvivors compared to other methods. The MELD score is widely used for organ allocation in liver transplantation. Recent reports indicate that the PWR is a potential biomarker for predicting clinical outcomes. The ALBI score is a new score model for evaluating the severity of liver dysfunction. We aimed to compare these prognosis models to predict short-term mortality in ACLF patients.Methods: A retrospective analysis of 89 ACLF patients between 2015 and 2018 was performed. The receiver operating characteristic (ROC) curve was used to assess the power of four prognosis models for predicting 28-day mortality in patients with ACLF.Results: The ALBI score, MELD score and CLIF-SOFA score were significantly higher, and the PWR was slightly lower in nonsurviving ACLF patients than in surviving patients. The MELD score and ALBI score were positively correlated with the CLIF-SOFA score, while the PWR was inversely related to the CLIF-SOFA score. The area under the ROC curves (AUROCS) of the CLIF-SOFA score, PWR, ALBI score and MELD score were 0.804, 0.759, 0.710 and 0.670, respectively.Conclusion: The CLIF-SOFA score, PWR and ALBI score can better predict 28-day mortality in ACLF patients, but the MELD score has worse predictability. The CLIF-SOFA score is the best prognosis model among these models. PWR may be a simple and useful tool that can predict 28-day outcome.Keywords: CLIF-SOFA score, platelet-to-white blood cell ratio, albumin-bilirubin score, acute-on-chronic liver failure, prognosis
