Premium
Simple organ failure count versus CANONIC grading system for predicting mortality in acute‐on‐chronic liver failure
Author(s) -
Agrawal Swastik,
Duseja Ajay,
Gupta Tarana,
Dhiman Radha K,
Chawla Yogesh
Publication year - 2015
Publication title -
journal of gastroenterology and hepatology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.214
H-Index - 130
eISSN - 1440-1746
pISSN - 0815-9319
DOI - 10.1111/jgh.12778
Subject(s) - medicine , cirrhosis , gastroenterology , etiology , liver failure
Background and Aim This study assessed the utility of a simple organ failure count ( SOFC ) in predicting the in‐hospital mortality in patients with acute‐on‐chronic liver failure ( ACLF ) compared with C hronic L iver F ailure A cute‐on‐ C hronic L iver F ailure in C irrhosis ( CANONIC ) ACLF grading system. Methods Consecutive patients of ACLF were included prospectively from 2012 to 2013. The diagnosis was based on A sian‐ P acific A ssociation for the S tudy of the L iver ( APASL ) criteria except for the inclusion of non‐hepatic insults as acute events. Organ failures were defined as per the C hronic L iver F ailure– S equential O rgan F ailure A ssessment system. SOFC was calculated as the simple number of organ failures from 0 to 6. In‐hospital mortality was recorded. Results Majority (92[87%]) of the 106 patients included were males, had alcohol (76[72%]) as the etiology of cirrhosis, and alcoholic hepatitis (58[55%]) as the acute precipitating event. Overall, 51(48%) patients died in‐hospital. In‐hospital mortality in patients with SOFC of 0 ( n = 9), 1 ( n = 39), 2 ( n = 24), 3 ( n = 24), 4 ( n = 7), and 5 ( n = 3) was 0%, 26%, 58%, 71%, 100%, and 100% respectively ( P < 0.001), whereas it was 10%, 30%, 58%, and 79% in patients with no‐ ACLF ( n = 21), grades 1 ( n = 27), 2 ( n = 24), and 3 ACLF ( n = 34) respectively ( P < 0.001). Patients with no‐ ACLF ( n = 21) had higher mortality than SOFC 0 as they included 9 patients with SOFC 0 (0% mortality) and 12 patients with SOFC 1 (17% mortality). Mortality was similar between 12 no‐ ACLF and 27 grade 1 ACLF patients ( P = 0.462) that comprised SOFC 1. Conclusion SOFC is a simpler and better method than the CANONIC grading system for predicting the in‐hospital mortality in patients with ACLF defined as per APASL criteria.