CLIF-C-ACLF scale to predict mortality in pediatric patients with acute-on-chronic liver failure

Abstract

Introduction and Objectives: The acute decompensation of liver cirrhosis associated with organ failure is known as acute-on-chronic liver failure (ACLF); in pediatrics, it develops >22%, with mortality >33% per month; Based on prognosis, CLIF-C ACLF is a score with greater discriminative capacity to predict short-term mortality (25%) compared to already established scales, which require more complex variables. To describe the utility of the CLIF-C ACLF scale in pediatrics. Specific: In children with cirrhosis who developed ACLF: Describe the sociodemographic, clinical, and biochemical characteristics; Determine the MELD, PELD, Child Pugh, AARC and CLIF-C ACLF scales and compare their predictive value. Materials and Patients: Retrospective cohort, age: 6 months to 18 years, temporality: March 2018 - February 2022. Frequency and percentage were reported for qualitative variables, and median variables and range for quantitative variables; Inferential with Pearson and Spearman correlation between the scales at admission, 28 and 90 days, an area under the receiver operating characteristics (AUROC) and Whitney U were calculated. Results: Out of 95 cases with chronic liver disease, 63.1% presented ACLF, mostly stage II (35.3%). The female sex predominated (72.1%) and bile duct atresia was the most common entity (80%), with a mean age at diagnosis of 38 months and mortality of 55%. Ascites (97%) and hepatic encephalopathy (58.3%) were the main complications. The major precipitating factors described were infections (57.4%): bacterial cholangitis (16.2%) and pneumonia (8.8%). Through AUROC we compared CLIF cACLF with PELD, MELD, Child Pugh and AARC, observing greater statistical significance at 28 and 90 days (sensitivity: 0.63, specificity: 0.85) and through the U test, we observed that coagulopathy is the biochemical index with higher prediction for acute decompensation in ACLF. Conclusions: CLIF-C ACLF compared to ACLF scores predicted increased risk of 28-day mortality (AUROC: 0.758) relative to PELD, MELD (AUROC: 0.721), Child Pugh (AUROC: 0.746), AARC (AUROC: 0.621), and at 90 days (AUROC: 0.663) with PELD, MELD (AUROC: 0.505), Child Pugh (AUROC: 0.598), AARC (AUROC: 0.357). We established a CLIF-C ACLF score ≥ 77.5 as a high predictor of mortality (95% CI). The scale is useful in pediatrics.