![]() The conventional scoring systems, the Model for End-stage Liver Disease (MELD) score, the MELD score refined to take into account serum sodium level (MELD-Na) and the Child-Pugh-Turcotte classification, were designed to predict the prognosis of chronic liver failure. These scoring systems are also commonly used to determine prognosis in ACLF. The accuracy of these scores in predicting the prognosis of ACLF is, however, limited by their inability to incorporate all possible extrahepatic organ failures, which are an important part of the disease spectrum and have a significant impact on prognosis. Thus, it becomes very important to determine prognosis, as prognosis can help to monitor response to treatment, determine the need for emergency transplantation and provide the rationale for deciding on the futility of ICU care. Such patients often require artificial support therapies and admission to an intensive care unit. Prognosis of ACLF is related to the number and severity of organ failures. Determining prognosis, therefore, helps to monitor treatment response, determine the need for emergency transplantation and provide the rationale for deciding on the futility or otherwise of ICU care.ĪCLF is a very serious complication of hepatic cirrhosis that is characterized by hepatic and extrahepatic organ failure and is associated with high short-term mortality. 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. 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.
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