Tang et al reported an algorithm for identifying a patient with acute decompensation of cirrhosis who is at risk for acute-on-liver failure (ACLF) within the next 28 days. The authors are from multiple institutions in China.
Patient selection: acute decompensation of cirrhosis
Parameters:
(1) serum total bilirubin in mg/dL (marker of liver dysfunction)
(2) serum creatinine in mg/dL (marker of renal dysfunction)
(3) INR (marker of coagulation dysfunction)
(4) proven bacterial infection (marker of immune system dysfunction)
Parameter
Finding
Points
serum total bilirubin
< 6 mg/dL
0
>= 6 mg/dL
1
serum creatinine
< 1.5 mg/dL
0
>= 1.5 mg/dL
1
INR
< 1.5
0
>= 1.5
1
proven bacterial infection
no
0
yes
1
where:
• Renal dysfunction was a defined as serum creatinine from 1.5 to 1.9 mg/dL. Renal failure was defined as a serum creatinine >= 2.0 mg/dL.
number of organ dysfunctions =
= SUM(points for the four parameters)
Interpretation:
• minimum number of organ dysfunctions: 0
• maximum number of organ dysfunction: 4
Number of Organ Dysfunctions
Risk of Acute-on-Chronic Liver Failure at 28 Days
1-Year Transplant-Free Mortality
0 or 1
0.4%
9.8 to 10.4%
2 to 4
20.1 to 23.8%
30.8 to 33.8%
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