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

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.

Ethical statement

The protocol was registered and approved by the Ethics Committee. The identity of the patients is protected. Consentment was obtained.

Declaration of interests

None

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

AUROC of CLIF-C ACLF, MELD/PELD, Child Pugh, AARC in predicting at admission, 28- and 90 - days mortality.