Key result
SAPS 3 and CLIF-C ACLF scores accurately predict 90-day mortality in cirrhosis patients, reaching ~0.83 AUROC.
Why the study?
Re-evaluations of mortality prediction score performances are required to warrant their validity in cirrhotic patients admitted to intermediate care units.
Which mortality prediction score best predicts 90-day mortality in patients with liver cirrhosis admitted to intermediate care units?
Observational (n=98)
No
Which mortality prediction score best predicts 90-day mortality in patients with liver cirrhosis admitted to intermediate care units?
SAPS 3 and CLIF-C ACLF scores accurately predict 90-day mortality in patients with liver cirrhosis admitted to intermediate care units, though prediction in ACLF patients remains challenging.
Answers are grounded in this paper and cite their sources.
May support risk stratification with SAPS 3 or CLIF-C ACLF in cirrhotic intermediate-care patients; leaves open prospective validation and ACLF-specific performance.
BACKGROUND AND AIMS: Mortality prediction models help to extract and relate patient data upon admission to intensive or intermediate care units (ImCUs). Considering technical and economic healthcare developments, re-evaluations of score performances are required to warrant their validity. This study validates and compares established scoring systems in cirrhotic ImCU patients. METHODS: Acute Physiology and Chronic Health Evaluation (APACHE) II, Simplified Acute Physiology Score (SAPS) 2 and 3, Sepsis Organ Failure Assessment (SOFA), Mortality Probability Model at ICU admission (MPMo) II and III, Model for End stage Liver Disease (MELD), CLIF-Consortium Acute-on-Chronic Liver Failure (CLIF-C ACLF), CLIF-Consortium Acute Decompensation (CLIF-C AD), and Intermediate Care Unit Severity Score (ImCUSS) were calculated in patients with cirrhosis (n = 98) at ImCU admission. Discrimination performances were evaluated by area under the receiver operating characteristic curves (AUROCs), calibration performances with calibration belt plots, and their corresponding p values. RESULTS: Overall, SAPS 3 and CLIF-C ACLF have shown the best 90-day mortality prediction outcomes with AUROCs of 0.825 and 0.783 along with calibration belt p values of 0.128 and 0.061, respectively. In a subgroup analysis of patients with acute-on-chronic liver failure (ACLF), expanded SAPS 2, SOFA, and SAPS 3 reached the best AUROCs, i.e., 0.760, 0.750, and 0.714, but none of the tested scores reached an acceptable calibration. CONCLUSION: Ninety-day mortality risk prediction of the SAPS 3 and CLIF-C ACLF was accurate in our cohort of patients with liver cirrhosis admitted to ImCUs. A particular challenge remains that is the mortality prediction in patients with ACLF requiring ImCU-level care; here, further developments are needed to generate scores with acceptable predictive performances.
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Jahn et al. (2022) conducted an observational in Liver cirrhosis (n=98). SAPS 3 and CLIF-C ACLF scores vs. Other mortality prediction scores was evaluated on 90-day mortality prediction (AUROC 0.825 and 0.783). SAPS 3 and CLIF-C ACLF scores accurately predicted 90-day mortality in intermediate-care patients with liver cirrhosis, achieving AUROCs of 0.825 and 0.783, respectively.
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