Prognostic value of CLIF-C-ACLF scale for short-term mortality in alcoholic cirrhosis

• Main Authors: N. H. Virstiuk, N. O. Slyvka
• Format: Article
• Language: English
• Published: Zaporozhye State Medical University 2018-04-01
• Series: Zaporožskij Medicinskij Žurnal
• Subjects: alcoholic liver cirrhosis; mortality; CLIF-C-ACLF scale
• Online Access: http://zmj.zsmu.edu.ua/article/view/124935/124576

Introduction. The concept of acute-on-chronic liver failure (ACLF) covers the acute deterioration of liver function in patients with alcoholic liver cirrhosis (ALC) caused by secondary or extrahepatic provoking factors - precipitating factors (PF), leading to dysfunction of target organs. Scale CLIF-C-ACLF takes into account the number of decompensated organs/systems and is recommended for predicting outcome in patients with ALC. Objective - to compare the diagnostic value of Child-Pugh scale and CLIF-C-ACLF scale for predicting short-term mortality (STMP) in patients with ALC. Materials and methods. Clinical data of 150 patients with ALC were analyzed retrospectively. Enrolled patients were divided into 2 groups according to the presence/absence of PF 3 months prior to the death: I group (n = 83) - without PF (CLF), II group (n = 67) – with PF (ACLF). To assess the ALC severity we used Child-Pugh scale and CLIF-C-ACLF scale. Infectious complications were considered as PF. Results. The sensitivity of STMP on the Child-Pugh scale in group I was 100% (95 % CI 58.9–100), specificity - 38.9 % (95 % CI 30.9–47.4). The sensitivity on the CLIF-C-ACLF scale was 100 % (95 % CI 58.9–100), specificity – 93.75 % (95 % CI 88.5–97.1). The sensitivity of STMP on the Child-Pugh scale in group II was 100% (95% CI 54,1-100), specificity – 29.5 % (95 % CI -42.6 to 18.5). The sensitivity of STMP on the CLIF-C-ACLF scale in group II was 100 % (95 % CI 58.9–100), specificity - 88.5 % (95 % CI 77.8–95.2). The area under the ROC curve for the scale CLIF-C-ACLF corresponded to the model of excellent quality in groups I (0.99) and II (0.97) and was higher than for Child-Pugh scale in both groups (P = 0.012 and P = 0.015, respectively). Conclusions: The diagnostic value of CLIF-C-ACLF scale for predicting short-term mortality in patients with ALC is higher than Child-Pugh, especially for acute decompensated ALC caused by precipitating factors.