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Comparing Eight Prognostic Scores in Predicting Mortality of Patients with Acute-On-Chronic Liver Failure Who Were Admitted to an ICU: A Single-Center Experience

1
Division of Hepatology, Department of Gastroenterology and Hepatology, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
2
Biostatistics Unit, Clinical Trial Center, Chang-Gung Memorial Hospital, Linkou Medical Center, Taoyuan 333, Taiwan
3
College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
4
Graduate Institute of Clinical Medical Sciences, College of Medicine, Chang-Gung University, Taoyuan 333, Taiwan
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(5), 1540; https://doi.org/10.3390/jcm9051540
Received: 3 March 2020 / Revised: 16 May 2020 / Accepted: 17 May 2020 / Published: 20 May 2020
(This article belongs to the Section Emergency Medicine)
Limited data is available on long-term outcome predictions for patients with acute-on-chronic liver failure (ACLF) in an intensive care unit (ICU) setting. Assessing the reliability and accuracy of several mortality prediction models for these patients is helpful. Two hundred forty-nine consecutive patients with ACLF and admittance to the liver ICU in a single center in northern Taiwan between December 2012 and March 2015 were enrolled in the study and were tracked until February 2017. Ninety-one patients had chronic hepatitis B-related cirrhosis. Clinical features and laboratory data were collected at or within 24 h of the first ICU admission course. Eight commonly used clinical scores in chronic liver disease were calculated. The primary endpoint was overall survival. Acute physiology and chronic health evaluation (APACHE) III and chronic liver failure consortium (CLIF-C) ACLF scores were significantly superior to other models in predicting overall mortality as determined by time-dependent receiver operating characteristic (ROC) curve analysis (area under the ROC curve (AUROC): 0.817). Subgroup analysis of patients with chronic hepatitis B-related cirrhosis displayed similar results. CLIF-C organ function (OF), CLIF-C ACLF, and APACHE III scores were statistically superior to the mortality probability model III at zero hours (MPM0-III) and the simplified acute physiology (SAP) III scores in predicting 28-day mortality. In conclusion, for 28-day and overall mortality prediction of patients with ACLF admitted to the ICU, APACHE III, CLIF-OF, and CLIF-C ACLF scores might outperform other models. Further prospective study is warranted. View Full-Text
Keywords: acute-on-chronic liver failure (ACLF); APACHE III; CLIF-OFs; CLIF-C ACLF; specialized liver intensive care unit; Time-dependent ROC curve acute-on-chronic liver failure (ACLF); APACHE III; CLIF-OFs; CLIF-C ACLF; specialized liver intensive care unit; Time-dependent ROC curve
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MDPI and ACS Style

Chen, B.-H.; Tseng, H.-J.; Chen, W.-T.; Chen, P.-C.; Ho, Y.-P.; Huang, C.-H.; Lin, C.-Y. Comparing Eight Prognostic Scores in Predicting Mortality of Patients with Acute-On-Chronic Liver Failure Who Were Admitted to an ICU: A Single-Center Experience. J. Clin. Med. 2020, 9, 1540.

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