APACHE II score is superior to SOFA, CTP and MELD in predicting the short-term mortality in patients with acute-on-chronic liver failure (ACLF).

Abstract

OBJECTIVE:

The aim of the study was to assess the performance of various prognostic scores including the acute physiology and chronic health evaluation (APACHE II), sequential organ failure assessment (SOFA), Child-Turcotte-Pugh (CTP) and model for end-stage liver disease (MELD) scores in predicting short-term mortality in patients with acute-on-chronic liver failure (ACLF).

METHODS:

Altogether 100 consecutive patients with ACLF were evaluated prospectively. The diagnosis of ACLF was based on the Asian-Pacific Association for the Study of the Liver criteria except for the inclusion of non-hepatic insults as acute events. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy for predicting short-term mortality was calculated for APACHE II, SOFA, CTP and MELD in all patients and Maddrey's discriminant function (DF) and Glasgow alcoholic hepatitis scores (GAHS) for patients with alcoholic hepatitis only.

RESULTS:

Most patients had alcohol-related cirrhosis and alcoholic hepatitis as acute insults for ACLF. A total of 53 patients either died or left hospital in very sick status and were confirmed to have died the same day after leaving hospital. Overall, the area under the receiver operating characteristic curve of APACHE II was higher than those of MELD, SOFA and CTP scores for predicting short-term mortality. Even for patients with alcoholic hepatitis, APACHE II performed better than DF and GAHS.

CONCLUSIONS:

Short-term mortality is high in patients with ACLF. APACHE II scoring system is superior to other prognostic scores in predicting its short-term mortality.

• Authors: Ajay Duseja, Narendra S Choudhary, Sachin Gupta, Radha Krishan Dhiman, Yogesh Chawla
• Journal: Journal of digestive diseases (J Dig Dis) Vol. 14 Issue 9 Pg. 484-90 (Sep 2013) ISSN: 1751-2980 [Electronic] Australia
• PMID: 23692973 (Publication Type: Comparative Study, Journal Article)
• Copyright: © 2013 Wiley Publishing Asia Pty Ltd and Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine.

Chemical References

• Biomarkers

Topics

• APACHE
• Adult
• Biomarkers (blood)
• Female
• Hepatitis, Alcoholic (complications, mortality)
• Humans
• India (epidemiology)
• Infections (complications, mortality)
• Length of Stay (statistics & numerical data)
• Liver Failure, Acute (diagnosis, etiology, mortality)
• Male
• Middle Aged
• Predictive Value of Tests
• Prognosis
• Prospective Studies
• Sensitivity and Specificity
• Severity of Illness Index