Accuracy of different scores for prediction of 28-day mortality in patients with acute-on-chronic liver cell failure

Abstract Background Acute-on-chronic liver failure (ACLF) is characterized by rapid deterioration of different liver function tests resulting in high short-term and even long-term mortality. This study was designed to validate the applicability of ACLF different scoring models and compare their ability in predicting the inhospital 28-day mortality rate to facilitate early treatment options and thereby decrease mortality rates. Materials and methods This was a prospective observational study. One hundred twenty-eight patients admitted in Aswan University Hospital were enrolled in the study between October 2023 and December 2024. ACLF was diagnosed by applying EASL-CLIF criteria. The demographic, clinical, laboratory, and radiological characteristics of the patients were obtained. Variable scores (CTP, MELD, CLIF SOFA, and CLIF-C ACLF scores) were calculated at admission. All patients were observed until loss to follow-up or 28 days after admission. Receiver operating characteristic (ROC) curves were used with the aim to measure these scores’ performance for the prediction of 28-day mortality. Results Seventy patients (54.69%) were survivors, while 38 patients (29.69%) were non-survivors. Twenty patients (15.62%) were lost during follow-up. The non-surviving patients had a higher CTP, MELD, CLIF-SOFA, and CLIF-C ACLF scores, compared with surviving patients ( P < 0.001). When comparing different scores, only CLIF-C ACLF score showed area under the curve (AUC) value above 0.9. AUC values of CLIF-SOFA, CTP, and MELD were 0.86, 0.84, and 0.79, respectively. Therefore, it was superior to the other three scores as regards 28-day mortality. Conclusion CLIF-SOFA, CLIF-C ACLF, CTP, and MELD scores represent effective measures for prediction of 28-day mortality in ACLF patients. Among these valuable scores, CLIF-C ACLF score is found to have the highest accuracy for predicting mortality.