Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 7, 2016; 22(41): 9205-9213
Published online Nov 7, 2016. doi: 10.3748/wjg.v22.i41.9205
Assessment of scoring systems for acute-on-chronic liver failure at predicting short-term mortality in patients with alcoholic hepatitis
Hee Yeon Kim, Chang Wook Kim, Tae Yeob Kim, Do Seon Song, Dong Hyun Sinn, Eileen L Yoon, Young Kul Jung, Ki Tae Suk, Sang Soo Lee, Chang Hyeong Lee, Tae Hun Kim, Jeong Han Kim, Hyung Joon Yim, Sung Eun Kim, Soon Koo Baik, Byung Seok Lee, Jae Young Jang, Young Seok Kim, Sang Gyune Kim, Jin Mo Yang, Joo Hyun Sohn, Heon Ju Lee, Seung Ha Park, Eun Hee Choi, Dong Joon Kim
Hee Yeon Kim, Chang Wook Kim, Do Seon Song, Jin Mo Yang, Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul 06591, South Korea
Tae Yeob Kim, Institute of Medical Science, Hanyang University, Seoul, 04763, South Korea
Dong Hyun Sinn, Department of Internal Medicine, Samsung Medical Center, Seoul 06351, South Korea
Eileen L Yoon, Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul 01757, South Korea
Young Kul Jung, Hyung Joon Yim, Department of Internal Medicine, Korea University Ansan Hospital, Ansan 15355, South Korea
Ki Tae Suk, Dong Joon Kim, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon 24253, South Korea
Sang Soo Lee, Department of Internal Medicine, Gyeongsang National University Hospital, Jinju 52727, South Korea
Chang Hyeong Lee, Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu 42472, South Korea
Tae Hun Kim, Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul 07985, South Korea
Jeong Han Kim, Department of Internal Medicine, Konkuk University School of Medicine, Seoul 05030, South Korea
Sung Eun Kim, Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang 14068, South Korea
Soon Koo Baik, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, South Korea
Byung Seok Lee, Department of Internal Medicine, Chungnam National University, School of Medicine, Daejeon 35015, South Korea
Jae Young Jang, Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul 04401, South Korea
Young Seok Kim, Sang Gyune Kim, Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon 14584, South Korea
Joo Hyun Sohn, Department of Internal Medicine, Hanyang University Guri Hospital, Guri 11923, South Korea
Heon Ju Lee, Department of Internal Medicine, Yeungnam University College of Medicine, Daegu 42415, South Korea
Seung Ha Park, Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan 48108, South Korea
Eun Hee Choi, Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju 26426, South Korea
Author contributions: Kim HY, Kim CW and Kim TY proposed the idea and designed the research; Kim DJ designed and supervised the study; Kim HY, Song DS, Sinn DH, Yoon EL, Jung YK, Suk KT, Lee SS, Lee CH, Kim TH, Kim JH, Yim HJ, Kim SE, Baik SK, Lee BS, Jang JY, Kim YS, Kim SG, Yang JM, Sohn JH, Lee HJ and Park SH enrolled patients and collected the data; Kim HY, Kim CW, Kim TY and Choi EH performed the statistical analysis and interpreted the data; Kim HY and Kim DJ wrote the draft; all authors have read and approved the final manuscript.
Supported by the Korean Association for the Study of the Liver (KASL) and the Korean Liver Foundation.
Institutional review board statement: The protocol was approved by the Ethics Review Board of Uijeongbu St. Mary’s Hospital (approval No. UC14RIMI0068).
Informed consent statement: As a retrospective review, a waiver of consent was granted by the Ethics Review Board of Uijeongbu St. Mary’s Hospital as the study satisfied that the research involves no more than minimal risk to the subjects, the waiver does not adversely affect the rights and welfare of research participants, and the research could not be practicably carried out without the waiver.
Conflict-of-interest statement: The authors declare that there are no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Dong Joon Kim, MD, PhD, Department of Internal Medicine, Hallym University Chuncheon Sacred Heart Hospital, Sakju-ro 77, 200-704, Chuncheon 24253, South Korea. djkim@hallym.ac.kr
Telephone: +82-33-2405646 Fax: +82-33-2418064
Received: June 24, 2016
Peer-review started: June 28, 2016
First decision: August 8, 2016
Revised: August 20, 2016
Accepted: September 14, 2016
Article in press: September 14, 2016
Published online: November 7, 2016
Processing time: 135 Days and 2.1 Hours
Abstract
AIM

To assess the performance of proposed scores specific for acute-on-chronic liver failure in predicting short-term mortality among patients with alcoholic hepatitis.

METHODS

We retrospectively collected data from 264 patients with clinically diagnosed alcoholic hepatitis from January to December 2013 at 21 academic hospitals in Korea. The performance for predicting short-term mortality was calculated for Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA), CLIF Consortium Organ Failure score (CLIF-C OFs), Maddrey’s discriminant function (DF), age, bilirubin, international normalized ratio and creatinine score (ABIC), Glasgow Alcoholic Hepatitis Score (GAHS), model for end-stage liver disease (MELD), and MELD-Na.

RESULTS

Of 264 patients, 32 (12%) patients died within 28 d. The area under receiver operating characteristic curve of CLIF-SOFA, CLIF-C OFs, DF, ABIC, GAHS, MELD, and MELD-Na was 0.86 (0.81-0.90), 0.89 (0.84-0.92), 0.79 (0.74-0.84), 0.78 (0.72-0.83), 0.81 (0.76-0.86), 0.83 (0.78-0.88), and 0.83 (0.78-0.88), respectively, for 28-d mortality. The performance of CLIF-SOFA had no statistically significant differences for 28-d mortality. The performance of CLIF-C OFs was superior to that of DF, ABIC, and GAHS, while comparable to that of MELD and MELD-Na in predicting 28-d mortality. A CLIF-SOFA score of 8 had 78.1% sensitivity and 79.7% specificity, and CLIF-C OFs of 10 had 68.8% sensitivity and 91.4% specificity for predicting 28-d mortality.

CONCLUSION

CLIF-SOFA and CLIF-C OF scores performed well, with comparable predictive ability for short-term mortality compared to the commonly used scoring systems in patients with alcoholic hepatitis.

Keywords: Acute-on-chronic liver failure; Alcoholic hepatitis; Mortality; Prognosis; Scoring system

Core tip: Alcoholic hepatitis (AH) often leads to acute-on-chronic liver failure (ACLF), which is characterized by acute hepatic decompensation of chronic liver disease, organ failure, and high short-term mortality. We investigated the prognostic utilities of proposed scores specific for ACLF in predicting short-term mortality among patients with AH. Chronic Liver Failure (CLIF)-Sequential Organ Failure Assessment and CLIF Consortium Organ Failure score performed well, and showed comparable predictive ability for short-term mortality compared to commonly used scoring systems proposed for AH. The present study suggests that scores proposed for ACLF could be useful in predicting short-term morality in patients with AH.