studies

1076A AASLD ABSTRACTS HEPATOLOGY, October, 2015
The following authors have nothing to disclose: Svenja Sydor, Paul P. Manka,
Sami Jafoui, Martin Schlattjan, Francisco Javier Cubero, Thomas Schreiter, Diana
Vetter, Andreas Paul, Guido Gerken, Ali Canbay, Lars Bechmann
1780
Liver specific organ failure scoring systems, CLIF-OF and
CLIF-ACLF are better than King’s College Hospital criteria
in predicting mortality in patients with Acute Liver
Failure (ALF) admitted to Intensive Care Unit
Francesco Figorilli 2,1 , Antonella Putignano 2 , Banwari Agarwal 3 ,
Rajiv Jalan 2 ; 1 Universita’ di Cagliari, Cagliari, Italy; 2 UCL Medical
School, Royal Free Campus, Liver failure group, UCL Institute for
Liver and Digestive Health, London, United Kingdom; 3 Intensive
Care Unit, Royal Free Hospital, Royal Free Hampstead NHS Trust,
University College London, London, United Kingdom
Background. ALF is a critical illness and a liver transplant (LT)
is often the only life-saving treatment. King’s College Hospital
criteria (KCH) are currently used to identify LT potential candidates.
Given high mortality and the organ shortage, a more
sensitive score is needed. In this study, nine different exiting
scores (MELD, UKELD, iMELD, APACHE2, APACHE3, SOFA,
KCH, CLIF-OF and CLIF-ACLF) were assessed at the admission
to find the best predictor of mortality. Methods. Transplanted
and non-transplanted patients were analysed separately and
further stratified in base of aetiology (Paracetamol overdose
(POD) or other causes (Non-POD)). Primary endpoint was the
3-month mortality of any cause. For each score we assessed the
area under the curve (AUC), the best cut-off value, sensitivity,
specificity and positive predictive value (PPV). Cox analysis
was used to identify the best predictor of 3-month mortality.
Results. 200 patients admitted between 1990-2014 in our
centre were included in this study (98 POD, female 65%, mean
age 38.3±12,8). 70/200 received a LT (19 POD, 51 Non-
POD), and 22 (31.4%) died within 3 months. In the Non LT
cohort (79 POD and 51 NON POD), the mortality rate was
41.5%. 90 patients fulfilled poor prognostic KCH criteria but
did not receive a LT (12 were not listed for psychiatric problem,
29 was considered too unwell for a LT and 31 spontaneously
recovered). 18/90 were listed but 12 died on the waiting list
and 6 improved. In Non-LT/Non-POD group CLIF-ACLF had
the best AUC (0.799) with 73.9% sensitivity and 70.8% PPV;
also it was the best mortality predictor in the multivariate analysis
(p=0.001; HR 1.09; 95%CI 1.04-1.16). In Non-LT/POD
CLIF-OF showed the second highest AUC (0.793) after SOFA
(0.799) but with a higher sensitivity (93.5% vs 77.4%). In
the univariate analysis CLIF-OF cut-off (12) had the highest
Hazard Ratio (38.9). In Cox regression SOFA was the only
significant in Non-LT/POD group (p