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Inicio Annals of Hepatology O-9 COMPARISON OF THE PERFORMANCE OF DIFFERENT SCORES FOR THE PREDICTION OF IN-H...
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Vol. 24. Núm. S1.
Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)
(septiembre 2021)
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Vol. 24. Núm. S1.
Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)
(septiembre 2021)
Open Access
O-9 COMPARISON OF THE PERFORMANCE OF DIFFERENT SCORES FOR THE PREDICTION OF IN-HOSPITAL MORTALITY IN PATIENTS WITH CIRRHOSIS AND BACTERIAL INFECTIONS
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Agustina Martinez Garmendia1, Maria Nelly Gutierrez Acevedo2, Sabrina Barbero3, Lorena del Carmen Notari3, Marina Agozino4, Jose Luis Fernandez4, Maria Margarita Anders5, Nadia Grigera5, Florencia Antinucci5, Orlando Orozco Ganem5, Maria Dolores Murga6, Daniea Perez6, Ana Palazzo6, Liria Martinez Rejtman7, Ivonne Giselle Duarte8, Julio Vorobioff9, Victoria Trevizan9, Sofía Bulaty9, Fernando Bessone9, José Daniel Bosia9..., Silvia Mabel Borzi10, Teodoro E. Stieben11, Adriano Masola11, Sebastian Eduardo Ferretti12, Diego Arufe13, Ezequiel Demirdjian13, Maria Pia Raffa13, Cintia Elizabet Vazquez14, Pablo Ruiz14, José Emanuel Martínez15, Hugo Fainboim16, Mirta Peralta16, Leandro Alfredo Heffner17, Andrea Odzak17, Melisa Dirchwolf18, Astrid Smud19, Manuel Mendizabal20, Carla Bellizzi21, Diego Giunta22, Marcelo Valverde23,24, Martin Elizondo23,24, Ezequiel Mauro1, Ana Martinez21, Jesica Tomatis18, Andres Bruno17, Agñel Ramos12, Josefina Pages20, Silvina Tevez4, Salvatore Piano25, Adrian Gadano1,22, Sebastián Marciano1,22Ver más
1 Hospital Italiano de Buenos Aires, Liver Unit, CABA, Argentina
2 Clinica Chapelco, San Martin de los Andes, Argentina
3 Hospital Churruca Visca, CABA, Argentina, San Martin de los Andes, Argentina
4 Sanatorio Güemes, CABA, Argentina
5 Hospital Aleman, CABA, Argentina
6 Hospital A.C. Padilla, San Miguel de Tucuman, Argentina
7 Hospital T J Schestakow, Mendoza, Argentina
8 Hospital 4 de Junio, Saenz Peña, Argentina
9 Hospital provincial del Centenario, Rosario, Argentina
10 Hospital Rossi, La Plata, Argentina
11 Hospital San Martín, Paraná, Argentina
12 Sanatorio Parque, Rosario, Argentina
13 Sanatorio Sagrado Corazon, CABA, Argentina
14 Hospital Regional de Rio Gallegos, Río Gallegos, Argentina
15 Sanatorio Boratti, Posadas, Argentina
16 Hospital Muñiz, CABA, Argentina
17 Hospital Argerich, CABA, Argentina
18 Hospital Privado de Rosario, Rosario, Argentina
19 Hospital Italiano de Buenos Aires, Infectious Diseases Section, ABH, CABA, Argentina
20 Hospital Universitario Austral, Pilar, Argentina
21 Hospital Fernández, CABA, Argentina
22 Hospital Italiano de Buenos Aires, Department of Research, CABA, Argentina
23 Hospital de Clinicas, Montevideo, Uruguay
24 Hospital Militar, Montevideo, Uruguay
25 Unit of Internal Medicine and Hepatology, Department of Medicine, University of Padova, Padova, Italy
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Vol. 24. Núm S1

Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)

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Background

Predicting short-term mortality in patients with cirrhosis and bacterial infections is challenging.

Aims

To compare the performance of various scores in predicting in-hospital mortality in this population.

Methods

We performed an analysis of the multicenter prospective cohort study of patients with cirrhosis with bacterial infections throughout Argentina and Uruguay (clinicatrials.gov.NCT03919032). Patients were classified according to the CLIF criteria as having ACLF or mere acute decompensation (AD). We evaluated the performance of scores of liver disease and infection severity in predicting in-hospital mortality. MELD, MELD-Na, and Quick SOFA (qSOFA) were computed in all patients. CLIF-AD was only computed in patients without ACLF, and CLIF-ACLF only in patients with ACLF. We plotted ROC curves and estimated their area under the curve (AUROC).

Results

We included 472 patients: 66% male, mean age 57 ± 12 years. Most frequent infections: SBP (30%) and urinary tract infection (25%). Overall, 332 (70%) patients had acute decompensation, and 140 (30%) ACLF. In-hospital mortality rate was 19%: 41% in patients with ACLF vs 10% in patients with AD (p<0,001). When we evaluated the AUROC of the entire cohort, MELD and MELD-Na performed similarly: 0.74 (95% CI 0.68-0.81) and 0.74 (95% CI 0.67-0.80), respectively; whereas qSOFA showed the lowest performance: 0.62 (95% CI 0.57-0.68). When evaluating only patients with ACLF, CLIF-ACLF performed significantly better than the other ones: AUROC 0.76 (95% CI 0.67-0.84, p =0.01). All scores performed poorly in patients with AD (Figure).

Conclusion

The best tool to predict in-hospital mortality in patients with infection-related ACLF was the CLIF-ACLF score. In patients with infection-related AD, all scores performed poorly. Evaluation of the scores performance is of paramount importance in different regions and for each complication of cirrhosis separately.

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