Utility of the CLIF-C AD score to assess readmission in patients with acute decompensation of non-ACLF cirrhosis.
Introduction and Objectives: Patients with cirrhosis who require hospitalization due to acute decompensation (ascites, digestive bleeding, hepatic encephalopathy, among others), have a variable adverse prognosis, depending on whether they have acute-on-chronic liver failure (ACLF), the CLIF-C AD tes...
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2025-04-01
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| Series: | Annals of Hepatology |
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| author | Cristian A. Oviedo-Garza Alejandro Peña-Montes María R. Herrero Maceda Scherezada M. Loza-Mejia |
| author_facet | Cristian A. Oviedo-Garza Alejandro Peña-Montes María R. Herrero Maceda Scherezada M. Loza-Mejia |
| author_sort | Cristian A. Oviedo-Garza |
| collection | DOAJ |
| description | Introduction and Objectives: Patients with cirrhosis who require hospitalization due to acute decompensation (ascites, digestive bleeding, hepatic encephalopathy, among others), have a variable adverse prognosis, depending on whether they have acute-on-chronic liver failure (ACLF), the CLIF-C AD test allows to identify the risk of readmission, development of ACLF and mortality. Materials and Patients: A cross-sectional study was carried out between October 2023 and May 2024. The CLIF-C AD test was calculated in patients with decompensated cirrhosis. The results were analyzed using descriptive statistics, frequency analysis, and percentages. Group comparison analysis was performed with Student's T and chi square as appropriate, to determine the sensitivity and specificity of this test, and a ROC curve was performed; Likewise, Kaplan Meyer curves of 2 groups were used according to the CLIF-C AD categorized as 62 or less and greater than 62; having a significant value of p:0.005; The analysis was performed with the statistical program SPSS version 25. Results: There were 40 patients; 32 men and 8 women. Cirrhosis etiology: alcohol 30 patients (75%), MASLD 8 patients (20%), autoimmune hepatitis 2 patients (5%). Cause of decompensation: Upper digestive bleeding in 19 patients (47.5%), urinary infection in 8 patients (20%), tense ascites in 4 patients (10%), spontaneous bacterial peritonitis in 3 patients (7.5%). Findings on admission: ascites 27 patients (67.5%), hepatic encephalopathy 27 patients (67.5%), shock 18 patients (45%). The CLIF-C-AD score with a median of 68 IQR (52-73). Readmission 35 patients (87.5%); The cause of readmission was hepatic encephalopathy in 17 patients (42.5%), upper digestive bleeding in 10 patients (25%), and acute kidney injury in 3 patients (7.5%). Using Student's T, the CLIF-C AD score is determined for those who were readmitted with a mean of 66 and for those who were not readmitted with a mean of 41 (p<0.001). In the ROC curve, the area under the curve was found to be 0.950 with 95% CI (0.890-1.000) p=0.001, sensitivity 77%, specificity 100%, with a Youden point of 62 points; Therefore, it is categorized into 2 groups based on this score for a cumulative incidence of readmission by Kaplan Meier curve, showing a difference between the groups with a Log Rang test of 0.005. Conclusions: The CLIF-C AD score is a practical, adequate, and useful tool to determine the outcome of decompensated cirrhotic patients, which will allow the identification of high-risk patients and the implementation of close follow-up strategies and timely therapeutic adjustment and avoid adverse outcomes. More studies are required and increased sample size. |
| format | Article |
| id | doaj-art-c9342f77273643c7bb974445bc10f342 |
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| series | Annals of Hepatology |
| spelling | doaj-art-c9342f77273643c7bb974445bc10f3422025-08-20T02:13:48ZengElsevierAnnals of Hepatology1665-26812025-04-013010187610.1016/j.aohep.2025.101876Utility of the CLIF-C AD score to assess readmission in patients with acute decompensation of non-ACLF cirrhosis.Cristian A. Oviedo-Garza0Alejandro Peña-Montes1María R. Herrero Maceda2Scherezada M. Loza-Mejia3Gastroenterology and Hepatology, Hospital Juárez, MéxicoGastroenterology and Hepatology, Hospital Juárez, MéxicoGastroenterology and Hepatology, Hospital Juárez, MéxicoGastroenterology and Hepatology, Hospital Juárez, MéxicoIntroduction and Objectives: Patients with cirrhosis who require hospitalization due to acute decompensation (ascites, digestive bleeding, hepatic encephalopathy, among others), have a variable adverse prognosis, depending on whether they have acute-on-chronic liver failure (ACLF), the CLIF-C AD test allows to identify the risk of readmission, development of ACLF and mortality. Materials and Patients: A cross-sectional study was carried out between October 2023 and May 2024. The CLIF-C AD test was calculated in patients with decompensated cirrhosis. The results were analyzed using descriptive statistics, frequency analysis, and percentages. Group comparison analysis was performed with Student's T and chi square as appropriate, to determine the sensitivity and specificity of this test, and a ROC curve was performed; Likewise, Kaplan Meyer curves of 2 groups were used according to the CLIF-C AD categorized as 62 or less and greater than 62; having a significant value of p:0.005; The analysis was performed with the statistical program SPSS version 25. Results: There were 40 patients; 32 men and 8 women. Cirrhosis etiology: alcohol 30 patients (75%), MASLD 8 patients (20%), autoimmune hepatitis 2 patients (5%). Cause of decompensation: Upper digestive bleeding in 19 patients (47.5%), urinary infection in 8 patients (20%), tense ascites in 4 patients (10%), spontaneous bacterial peritonitis in 3 patients (7.5%). Findings on admission: ascites 27 patients (67.5%), hepatic encephalopathy 27 patients (67.5%), shock 18 patients (45%). The CLIF-C-AD score with a median of 68 IQR (52-73). Readmission 35 patients (87.5%); The cause of readmission was hepatic encephalopathy in 17 patients (42.5%), upper digestive bleeding in 10 patients (25%), and acute kidney injury in 3 patients (7.5%). Using Student's T, the CLIF-C AD score is determined for those who were readmitted with a mean of 66 and for those who were not readmitted with a mean of 41 (p<0.001). In the ROC curve, the area under the curve was found to be 0.950 with 95% CI (0.890-1.000) p=0.001, sensitivity 77%, specificity 100%, with a Youden point of 62 points; Therefore, it is categorized into 2 groups based on this score for a cumulative incidence of readmission by Kaplan Meier curve, showing a difference between the groups with a Log Rang test of 0.005. Conclusions: The CLIF-C AD score is a practical, adequate, and useful tool to determine the outcome of decompensated cirrhotic patients, which will allow the identification of high-risk patients and the implementation of close follow-up strategies and timely therapeutic adjustment and avoid adverse outcomes. More studies are required and increased sample size.http://www.sciencedirect.com/science/article/pii/S1665268125001000 |
| spellingShingle | Cristian A. Oviedo-Garza Alejandro Peña-Montes María R. Herrero Maceda Scherezada M. Loza-Mejia Utility of the CLIF-C AD score to assess readmission in patients with acute decompensation of non-ACLF cirrhosis. Annals of Hepatology |
| title | Utility of the CLIF-C AD score to assess readmission in patients with acute decompensation of non-ACLF cirrhosis. |
| title_full | Utility of the CLIF-C AD score to assess readmission in patients with acute decompensation of non-ACLF cirrhosis. |
| title_fullStr | Utility of the CLIF-C AD score to assess readmission in patients with acute decompensation of non-ACLF cirrhosis. |
| title_full_unstemmed | Utility of the CLIF-C AD score to assess readmission in patients with acute decompensation of non-ACLF cirrhosis. |
| title_short | Utility of the CLIF-C AD score to assess readmission in patients with acute decompensation of non-ACLF cirrhosis. |
| title_sort | utility of the clif c ad score to assess readmission in patients with acute decompensation of non aclf cirrhosis |
| url | http://www.sciencedirect.com/science/article/pii/S1665268125001000 |
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