Z Gastroenterol 2019; 57(01): e31-e32
DOI: 10.1055/s-0038-1677124
2. Clinical Hepatology, Surgery, LTX
Georg Thieme Verlag KG Stuttgart · New York

The CLIF-C AD-score predicts mortality in patients with non-decompensated cirrhosis

J Grandt
1   Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
,
M Parsberg Werge
1   Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
,
N Kimer
1   Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
2   Centre of Diagnostic Imaging and Research, Department of Clinical Physiology and Nuclear Medicine, Copenhagen University Hospital Hvidovre, Denmark
,
S Møller
1   Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
,
J Trebicka
3   Deparment of Internal Medicine 1, University of Frankfurt, Germany; European Foundation for the Study of Chronic Liver Failure, Barcelona, Spain; Institute for Bioengineering of Catalonia, Barcelona, Spain; Faculty of Health Siences, University of Southern Denmark, Odense, Denmark
,
LL Gluud
1   Gastro Unit, Medical Division, Copenhagen University Hospital Hvidovre, Denmark
› Author Affiliations
Further Information

Publication History

Publication Date:
04 January 2019 (online)

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Introduction:

The CLIF-C AD-score has been developed to predict mortality in patients with cirrhosis and acute decompensation. Based on the face-validity of the score, the CLIF-C AD may also predict mortality in cirrhotic patients without acute decompensation. We therefore analyzed 296 patients with cirrhosis from a prospective database including patients undergoing liver vein catheterization at Hvidovre Hospital from 2002 to 2016 to test the predictive value of the CLIF-C AD score for mortality and to compare it to Child-Pugh, MELD and MELD-Na scores. Furthermore we studied the predictive value of cardiac output and HVPG grades.

Methods:

The portal venous pressure, cardiac output, and standard laboratory values were registered prospectively. Data are summarized using means ± Standard Error of the Mean. Mortality data were gathered from electronic patient records. Stata 15 was used for the statistical analyses. Survival data were analyzed using Kaplan Meier with log rank test and Cox-regression analyses adjusted for age and gender. The predictive ability of the CLIF-C AD score was assesed using ROC curves and results presented as C-index with 95% confidence intervals (Area under the ROC curve) with P-values.

Results:

75.3% of patients were male, the mean age 58.5 years, and 77% had alcoholic liver disease. (Mean MELD 11.09 ± 3.73, MELD-Na 13.81 ± 4.49, Child-Pugh score 7.16 ± 2.30, and CLIF-C AD-score 49.57 ± 6.55) The CLIF-C AD score predicted 90 day-mortality (0.710; 95% CI 0.591 – 0.829), Child-Pugh 0.733 (95% CI 0.592 – 0.873), MELD 0.658 (95% CI 0.464 – 0.873) and MELD-Na 0.696 (95% CI 0.524 – 0.868). Similar results were identified for 360-day mortality (0.730 for the CLIF-C AD score, 0.709 Child-Pugh, 0.673 MELD, and 0.741 MELD-Na). Cardiac output was no significant predictor for mortality in univariate Cox-regression. CLIF-C AD score and portal venous pressure gradient showed p-values < 0.001 in univariate, and remained independent predictors for mortality in multivariate Cox-regression.

Conclusion:

This study shows that the CLIF-C AD score predicts short term and long term mortality in cirrhosis. Further studies with larger study populations are needed to validate these results.