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Title:	The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure
Author:	Jalan, Rajiv; Pavesi, Marco; Saliba, Faouzi; Amorós, Àlex; Fernández, Javier; Holland-Fischer, Peter; Sawhney, Rohit; Mookerjee, Rajeshwar P.; Caraceni, Paolo; Moreau, Richard; Ginès i Gibert, Pere; Durand, François; Angeli, Paolo; Alessandria, Carlo; Laleman, Wim; Trebicka, Jonel; Samuel, Didier; Zeuzem, Stefan; Gustot, Thierry; Gerbes, A. L. (Alexander L.); Wendon, Julia; Bernardi, Mauro; Arroyo, Vicente
Notes:	BACKGROUND & AIMS: Cirrhotic patients with acute decompensation frequently develop acute-on-chronic liver failure (ACLF), which is associated with high mortality rates. Recently, a specific score for these patients has been developed using the CANONIC study database. The aims of this study were to develop and validate the CLIF-C AD score, a specific prognostic score for hospitalised cirrhotic patients with acute decompensation (AD), but without ACLF, and to compare this with the Child-Pugh, MELD, and MELD-Na scores. METHODS: The derivation set included 1016 CANONIC study patients without ACLF. Proportional hazards models considering liver transplantation as a competing risk were used to identify score parameters. Estimated coefficients were used as relative weights to compute the CLIF-C ADs. External validation was performed in 225 cirrhotic AD patients. CLIF-C ADs was also tested for sequential use. RESULTS: Age, serum sodium, white-cell count, creatinine and INR were selected as the best predictors of mortality. The C-index for prediction of mortality was better for CLIF-C ADs compared with Child-Pugh, MELD, and MELD-Nas at predicting 3- and 12-month mortality in the derivation, internal validation and the external dataset. CLIF-C ADs improved in its ability to predict 3-month mortality using data from days 2, 3-7, and 8-15 (C-index: 0.72, 0.75, and 0.77 respectively). CONCLUSIONS: The new CLIF-C ADs is more accurate than other liver scores in predicting prognosis in hospitalised cirrhotic patients without ACLF. CLIF-C ADs therefore may be used to identify a high-risk cohort for intensive management and a low-risk group that may be discharged early.
Subject(s):	-Cirrosi hepàtica -Malalties del fetge -Pronòstic mèdic -Hepatic cirrhosis -Liver diseases -Prognosis
Rights:	(c) Elsevier, 2015
Document type:	Article Article - Accepted version
Published by:	Elsevier
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