Annals of Hepatology (Sep 2021)

O-9 COMPARISON OF THE PERFORMANCE OF DIFFERENT SCORES FOR THE PREDICTION OF IN-HOSPITAL MORTALITY IN PATIENTS WITH CIRRHOSIS AND BACTERIAL INFECTIONS

  • Agustina Martinez Garmendia,
  • Maria Nelly Gutierrez Acevedo,
  • Sabrina Barbero,
  • Lorena del Carmen Notari,
  • Marina Agozino,
  • Jose Luis Fernandez,
  • Maria Margarita Anders,
  • Nadia Grigera,
  • Florencia Antinucci,
  • Orlando Orozco Ganem,
  • Maria Dolores Murga,
  • Daniea Perez,
  • Ana Palazzo,
  • Liria Martinez Rejtman,
  • Ivonne Giselle Duarte,
  • Julio Vorobioff,
  • Victoria Trevizan,
  • Sofía Bulaty,
  • Fernando Bessone,
  • José Daniel Bosia,
  • Silvia Mabel Borzi,
  • Teodoro E. Stieben,
  • Adriano Masola,
  • Sebastian Eduardo Ferretti,
  • Diego Arufe,
  • Ezequiel Demirdjian,
  • Maria Pia Raffa,
  • Cintia Elizabet Vazquez,
  • Pablo Ruiz,
  • José Emanuel Martínez,
  • Hugo Fainboim,
  • Mirta Peralta,
  • Leandro Alfredo Heffner,
  • Andrea Odzak,
  • Melisa Dirchwolf,
  • Astrid Smud,
  • Manuel Mendizabal,
  • Carla Bellizzi,
  • Diego Giunta,
  • Marcelo Valverde,
  • Martin Elizondo,
  • Ezequiel Mauro,
  • Ana Martinez,
  • Jesica Tomatis,
  • Andres Bruno,
  • Agñel Ramos,
  • Josefina Pages,
  • Silvina Tevez,
  • Salvatore Piano,
  • Adrian Gadano,
  • Sebastián Marciano

Journal volume & issue
Vol. 24
p. 100496

Abstract

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Background: Predicting short-term mortality in patients with cirrhosis and bacterial infections is challenging. Aims: To compare the performance of various scores in predicting in-hospital mortality in this population. Methods: We performed an analysis of the multicenter prospective cohort study of patients with cirrhosis with bacterial infections throughout Argentina and Uruguay (clinicatrials.gov.NCT03919032). Patients were classified according to the CLIF criteria as having ACLF or mere acute decompensation (AD). We evaluated the performance of scores of liver disease and infection severity in predicting in-hospital mortality. MELD, MELD-Na, and Quick SOFA (qSOFA) were computed in all patients. CLIF-AD was only computed in patients without ACLF, and CLIF-ACLF only in patients with ACLF. We plotted ROC curves and estimated their area under the curve (AUROC). Results: We included 472 patients: 66% male, mean age 57 ± 12 years. Most frequent infections: SBP (30%) and urinary tract infection (25%). Overall, 332 (70%) patients had acute decompensation, and 140 (30%) ACLF. In-hospital mortality rate was 19%: 41% in patients with ACLF vs 10% in patients with AD (p<0,001). When we evaluated the AUROC of the entire cohort, MELD and MELD-Na performed similarly: 0.74 (95% CI 0.68-0.81) and 0.74 (95% CI 0.67-0.80), respectively; whereas qSOFA showed the lowest performance: 0.62 (95% CI 0.57-0.68). When evaluating only patients with ACLF, CLIF-ACLF performed significantly better than the other ones: AUROC 0.76 (95% CI 0.67-0.84, p =0.01). All scores performed poorly in patients with AD (Figure). Conclusion: The best tool to predict in-hospital mortality in patients with infection-related ACLF was the CLIF-ACLF score. In patients with infection-related AD, all scores performed poorly. Evaluation of the scores performance is of paramount importance in different regions and for each complication of cirrhosis separately.