P-12 MELD 3.0 IS THE BEST PREDICTOR OF MORTALITY IN PATIENTS WITH ACUTE-ON-CHRONIC LIVER FAILURE (ACLF)

Introduction and Objectives

ACLF is a syndrome characterized by multiorgan failure due to acute decompensation in chronic liver disease, with high short-term mortality. Therefore, scales have been designed to predict prognosis and early mortality. This study aimed to evaluate MELD, MELD NA, MELD LACTATE, and MELD 3.0 scales for survival prediction in ACLF patients.

Materials and Methods

Observational, retrospective, and analytical study. The scales were calculated, and sensitivity (S) and specificity (E) were determined using CLIF-C-ACLF as a reference ROC curves. Cut-off points were established considering the value closest to the maximum S and 0.8 E. Cumulative mortality percentage was analyzed using Kaplan-Meier curves, and comparison of ACLF grades was performed with the significant Long-Rank test with p-value <0.005.

Results

233 patients were included, 165 (71%) males, with a mean age of 52 years ± 12.96. The etiology was alcohol-related in 158 (68%) cases. ACLF grade distribution, it was 1: 37%, 2: 41%, and 3: 22%. The MELD 3.0 showed the highest discriminatory power for ACLF grade 3, with AUC of 0.91 (95% CI:0.86-0.96), a cut-off point of 34.5, sensitivity of 86%, and specificity of 80% (Figure 1). The 2- year mortality rate was 123 (52%); 30 (35%), 51 (53%), and 42 (82%) for grades 1, 2, and 3, respectively, with a significant Log-Rank test, chi-square = 34.99, p <0.001. The mean survival by grades was 17 months for grade 1, 13 months for grade 2, and 5 months for grade 3.

Conclusions

MELD 3.0 scale showed better performance as a tool to evaluate severity and predict short-term mortality risk in ACLF patients.