Usefulness of lactate-free Asian Pacific Association for the Study of Liver acute-on-chronic liver failure (ACLF) Research Consortium (AARC) 'ACLF score for predicting short-term mortality in patients with alcoholic liver disease

Abstract

Background: Asian Pacific Association for the Study of Liver (APASL) acute-on-chronic liver failure (ACLF) Research Consortium (AARC) proposed new prognostic scoring system of ACLF including hepatic encephalopathy, bilirubin, international normalized ratio (INR), creatinine, and lactate. However, lactate is not routinely checked in clinical practice of patient with ACLF in some countries. Therefore, we aimed to investigate the predictive accuracy of lactatefree AARC-ACLF score for predicting short-term mortality in patients with alcoholic liver disease (ALD). Method: A total of 749 ALD patients who had liver failure (bilirubin = 5 mg/dL and INR =1.5) in AARC database were investigated. Diagnostic performances for short-term mortality were compared according to the area under receiver operating characteristic (AUROC) curve. Predictive accuracy of AARC-ACLF score and lactate-free AARC-ACLF score were compared with Child-Turcott-Pugh (CTP) score, model for end-stage liver disease (MELD), and MELD-Sodium (Na), chronic liver failure-sequential organ failure assessment (CLIF-SOFA) scores. The findings were validated in Korean ACLF cohort (212 ALD patients with liver failure and 108 ALD patients with ACLF according to AARC definition). Result: Of 708 patients, 286 (40.4%) and 363 (51.3%) patients died within 30 days and 90 days, respectively. The area under receiver operating characteristics curve (AUC) of AARC-ACLF, DF, ABIC, GAHS, CTP, MELD, and MELD-Na was 0.752 (0.705–0.799), 0.630 (0.575-0.685), 0.658 (0.604-0.711), 0.577 (0.523-0.631), 0.641 (0.589-0.694), 0.705 (0.653-0.756), 0.703 (0.651-0.755), respectively, for 30-day mortality. The AUC of various prognostic scores for the prediction of 90-day mortality is similar. The performance of AARCACLF was superior to that of DF, ABIC, GAHS, CTP, while comparable to that of MELD and MELD-Na in predicting short-term mortality. According to AARC-ACLF grades, short-term cumulative survivals was statistically different (30-day, 82.4, 70.4, and 35.3%, p\0.001; 90-day, 76.9, 56.0, and 26.4%, p\0.001). Conclusion: Compared to the previous AH prognostic scores, AARC-ACLF score and grades are simple and useful for predicting the short-term mortality in patients with AH. Further studies are needed to confirm these implications.