Predicting the immediate outcome in patients with acute on chronic liver disease by comparison of chronic liver failure-organ failure assessment, acute-on-chronic liver failure scores and meld scores

Background: Acute on chronic liver disease is determined by the acute deterioration of liver function over a short period of time. It leads to an increase in morbidity and mortality, hence scores like model for end-stage liver disease (MELD) and chronic liver failure-sequential organ failure (CLIF-C ACLF) are identified to determine prognosis. A comparison would help us in determining which score is better for predicting immediate outcomes. Methods: In this single centre study, patients of both genders, >18 years of age, >48 hours hospital stay with organ failure either ≤1, defined as, an increase in serum creatinine by 50% or more (1.5-fold from baseline), hepatic encephalopathy (HE) graded III/IV according to West haven criteria, liver failure, bilirubin ≥5 mg/dl, international normalized ratio (INR) ≥1.5 were enrolled after which relevant lab investigations and imaging was done and MELD and CLIF-C ACLF scores were applied, they were compared and analyzed. Results: Among 50 patients, 62% had grade 2, 36% had grade 3 and only 1 had grade 4 HE. Mean MELD score and CLIF- C ACLF scores were significantly high in patients who expired (both p<0.05), and the mean PaO2/FIO2 ratio was considerably low in patients with mortality (p=0.00). Sensitivity and specificity for CLIF-C ACLF score is much higher (90.9% and 100% respectively, with cut off value of 59), compared to the MELD score (77.3% and 60.7% respectively, with cut-off value of 25.50) Conclusions: CLIF-C ACLF score is a better predictor of mortality and for survival in ACLF than the MELD score in changing the outcome of the patient.