Evaluation of severity and survival scales in acute-on-chronic liver failure(ACLF) in a Mexican population sample.

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. Evaluation of MELD, MELD NA, MELD LACTATE, and MELD 3.0 scales for survival prediction in ACLF patients

Materials and Patients

Observational, retrospective, and analytical study, scales were calculated, and sensitivity (S) and specificity (E) were determined using CLIF-C-ACLF as reference through ROC curves. Cut-off points were established at the maximum values of S and E. Cumulative mortality percentage by Kaplan-Meier, and comparison of ACLF grades with the Long-Rank test with p<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% (Figures 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 (Figure 2)

Conclusions

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

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.

Figure 1. Comparative analysis between different scales in acute on chronic liver failures (ACLF). Meldlac: Meld Lactato

Figure 2. Kaplan-Meir. Survival by grades of acute on chronic liver failure (ACLF).