Performance of Five Prognostic Scores in Predicting Short-term Mortality in Patients with Acute-on-chronic Liver Failure

Background and aim: Acute-on-chronic liver failure (ACLF) is associated with rapid deterioration and very high short-term mortality.In addition to the traditional prognostic indices used in cirrhosis, various agencies have proposed scores to predict the survival of these conditions.This study aimed to compare the accuracy of the five most important prognostic scores in ACLF.Patients and methods: In this prospective observational study, 103 patients diagnosed with ACLF were included based on APASL criteria.Baseline characteristics, CTP, MELD, AARC, CLIF-C OF, and CLIF-C ACLF scores were estimated within 24 hours of admission to the hospital.Mortality after 28 days of admission was assessed on follow-up.The discriminative ability of the scores was primarily assessed using Harrell's concordance index (C-Index) from Cox proportional hazards models.Receiver operating characteristics (ROC) curve analysis was performed as an ancillary evaluation.Results: All patients completed the 28-day follow-up, with an overall mortality of 44.7%.Mortality rates were 9.1% in grade I, 31.4% in grade II, and 100% in grade III ACLF.Among patients who met the EASL-CLIF definition of ACLF (51.4%), the 28-day mortality was 76.1%.Harrell's C index values were: AARC -0.831 (95% CI: 0.779-0.882),CLIF-C ACLF -0.796, CLIF-C OF -0.794, MELD -0.769, and CTP -0.673.On ROC analysis, AUROCs for AARC, CLIF-C ACLF, CLIF-C OF, MELD, and CTP scores were 0.876, 0.850, 0.840, 0.821, and 0.696.Differences among AUROCs of AARC, CLIF-C ACLF, CLIF-C OF, and MELD were not statistically significant.AARC score has the highest AUROCs among patients with ACLF defined by the EASL-CLIF definition (0.84) as well as in ACLF caused by alcoholic hepatitis (0.94).Conclusion: Patients with ACLF, defined by APASL criteria, have high short-term mortality.Acute-on-chronic liver failure-specific scores and the MELD score demonstrated useful discriminative ability, with the AARC score showing relatively higher predictive accuracy for short-term survival.