Chronic liver failure-consortium acute-on-chronic liver failure and acute decompensation scores predict mortality in Brazilian cirrhotic patients

Table 1 Baseline clinical characteristics and acute-on-chronic liver failure grade according to group

	AD (n = 71)		AD evolving to ACLF (n = 24)		ACLF (n = 18)		ANOVA/pearson χ2
	No.	%	No.	%	No.	%	P value
	mean	SD	mean	SD	mean	SD
Sex							0.259
Male	48	67.6%	13	54.2%	14	77.8%
Age (yr)	57.8	10.2	62.6	8.0	61.3	12.9	0.097
Primary etiology of cirrhosis							0.592
Alcohol	23	32.4%	11	45.8%	9	50.0%
HBV	4	5.6%	0	0.0%	0	0.0%
HCV	34	47.9%	9	37.5%	6	33.3%
NASH	4	5.6%	1	4.2%	2	11.1%
Other	6	8.5%	3	12.5%	1	5.6%
Main cause of current hospital admission							0.035
SBP	0	0.0%	3	12.5%	2	11.1%
Ascites - not SBP	20	28.2%	7	29.2%	1	5.6%
Encephalopathy	15	21.1%	6	25.0%	5	27.8%
Alcoholic hepatitis	2	2.8%	2	8.3%	1	5.6%
Digestive bleeding	21	29.6%	2	8.3%	4	22.2%
Sepsis	0	0.0%	0	0.0%	1	5.6%
Other	13	18.3%	4	16.7%	4	22.2%
No. of previous hospitalizations	2.4	4.7	2.5	3.4	2.2	3	0.972
Alcohol consumption in the past three months							0.683
Yes	10	14.1%	6	25.0%	3	16.7%
West Haven HE grade at admission							0.005
No HE	54	76.1%	15	62.5%	7	38.9%
Grades I and II	13	18.3%	9	37.5%	7	38.9%
Grades III and IV	4	5.6%	0	0.0%	4	22.2%
Vasopressor at admission							0.070
Yes	0	0.0%	0	0.0%	1	5.6%
Mechanical ventilation at admission							< 0.001
Yes	0	0.0%	0	0.0%	3	16.7%
Mean arterial pressure (mmHg), n = 111	95.5	18.3	95.7	18.0	79.9	22.7	0.008
PaO2/FiO2 (mmHg), n = 17	476.0	173.5	380.0	No SD (n = 1)	352.4	152.5	0.341
SpO2/FiO2, n = 113	461.4	21.9	457.3	16.6	399.7	130.7	< 0.001
Child-Pugh score, n = 110	8.0	2.0	9.9	1.9	10.3	1.8	< 0.001
MELD score, n = 111	13.0	3.6	21.7	6.5	23.4	7.2	< 0.001
MELD-Na score, n = 111	14.0	4.6	23.8	5.8	23.9	8.9	< 0.001
CLIF-C OF score, n = 111	6.5	0.8	6.9	1.0	9.1	1.7	< 0.001
ACLF grade1
ACLF grade 1	NA	NA	17	70.8%	13	72.2%	1.000
ACLF grade 2	NA	NA	2	8.3%	4	22.2%	0.3752
ACLF grade 3	NA	NA	5	20.8%	1	5.6%	0.2142

¹For AD evolving to ACLF group, ACLF grade refers to classification at the time of ACLF diagnosis, not at the time of hospital admission;

²Fisher’s exact test. AD: Acute decompensation of cirrhosis; ACLF: Acute-on-chronic liver failure; ANOVA: Analysis of variance; HBV: Hepatitis B virus; HCV: Hepatitis C virus; NASH: Non-alcoholic steatohepatitis; SBP: Spontaneous bacterial peritonitis; HE: Hepatic encephalopathy; PaO₂: Arterial oxygen pressure; FiO₂: Inhaled oxygen fraction; SpO₂: Partial oxygen saturation; MELD: Model for End-Stage Liver Disease; MELD-Na: MELD sodium; CLIF-C OF: Chronic Liver Failure Consortium Organ Failure; NA: Not applicable.

Table 2 Baseline laboratory findings according to group

	AD (n = 71)		AD evolving to ACLF (n = 24)		ACLF (n = 18)		ANOVA
	Mean	SD	Mean	SD	Mean	SD	P value
Total bilirubin (mg/dL), n = 112	2.1	2.2	5.1	5.3	5.7	7.2	< 0.001
Serum creatinine (mg/dL), n = 113	1.0	0.3	1.2	0.4	2.1	0.8	< 0.001
INR, n = 112	1.4	0.3	1.5	0.5	1.8	0.4	< 0.001
White-cell count (109 cells/L), n = 113	6.9	3.7	8.8	3.6	12.6	6.1	< 0.001
Serum sodium (mmol/L), n = 113	138.4	3.9	136.1	4.3	137.6	5.6	0.070
Serum albumin (g/dL), n = 112	3.0	0.6	2.7	0.5	2.7	0.5	0.006
Serum C-reactive protein (mg/L), n = 47	25.5	33.0	41.9	32.0	77.5	61.7	0.003

AD: Acute decompensation of cirrhosis; ACLF: Acute-on-chronic liver failure; ANOVA: Analysis of variance; INR: International normalized ratio.

Table 3 Survival time and mortality according to group

Group (group symbol)	Survival time1			Mortality1
	Median (d)		Mantel-Cox	28-d mortality	90-d mortality	Death at any point during the study
	Estimate	(95%CI)	P value	n (%)	n (%)	n (%)
AD (A), n = 71	239	(166.4-311.6)	Reference group	6/67 (9.0)2	11/60 (18.3)2	18/60 (30.1)2
AD evolving to ACLF (B), n = 24	32	(0.0-64.4)	B vs A < 0.001;	12/24 (50.0)23	18/24 (75.0)23	18/24 (75.0)23
			B vs C = 0.247
ACLF (C), n = 18	11	(2.7-19.3)	C vs A < 0.001;	11/18 (61.1)23	15/18 (83.3)23	16/18 (88.9)23
			B + C vs A < 0.001
Overall, n = 113	165	(117.7-212.3)	Not applicable	29/109 (26.6)	44/102 (43.1)	52/102 (51.0)

¹Survival time and mortality for group B regards to time elapsed from the diagnosis of ACLF;

²Pearson’s χ²P values < 0.001 for comparisons across all groups;

³Fisher’s exact test P values for comparisons between groups B and C were 0.542, 0.708, and 0.431 for 28-d mortality, 90-d mortality, and death at any point during the study, respectively. AD: Acute decompensation of cirrhosis; ACLF: Acute-on-chronic liver failure.