NACSELD Acute-on-Chronic Liver Failure (NACSELD-ACLF) Score Predicts 30-Day Survival in Hospitalized Patients with Cirrhosis

Abstract

NACSELD (North American Consortium for the Study of End-Stage Liver Disease) definition of acute-on-chronic liver failure (NACSELD-ACLF) as ≥2 extra-hepatic organ failures has been proposed as a simple bedside tool to assess risk of mortality in hospitalized patients with cirrhosis. We validated NACSELD-ACLF's ability to predict 30-day survival (defined as in-hospital death or hospice discharge) in a separate multicenter prospectively enrolled cohort of both infected and uninfected hospitalized patients with cirrhosis. We utilized the NACSELD database of 14 tertiary care hepatology centers that prospectively enrolled non-elective hospitalized patients with cirrhosis (N=2675). The cohort was randomly split 60%/40% into training (N=1605) and testing (N=1070) groups. Organ failures assessed were: 1) shock, 2) hepatic encephalopathy (grade III/IV), 3) renal (need for dialysis), and 4) respiratory (mechanical ventilation). Patients were most commonly Caucasian (79%) men (62%) with a mean age of 57 years with a diagnosis of alcohol-induced cirrhosis (45%). 1079 patients had an infection during hospitalization. Mean Model for End-Stage Liver Disease (MELD) was 19 and median Child score was 10. No demographic differences were present between the 2 split groups. Multivariable modeling revealed NACSELD-ACLF score, as determined by number of organ failures, was the strongest predictor of decreased survival after controlling for admission age, white blood cell count, serum albumin, MELD score, and presence of infection. The c-statistic for the training set was 0.8073 and was 0.8532 for the validation set. Conclusion: Although infection status remains an important predictor of death, NACSELD-ACLF was independently validated in a separate large multinational prospective cohort as a simple reliable bed-side tool to predict 30-day survival in both infected and uninfected patients hospitalized with a diagnosis of cirrhosis. This article is protected by copyright. All rights reserved.

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