Materiały źródłowe

• #1 Acute Liver Failure Prognostic Criteria: It’s Time to Revisit

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9929612/

  Acute liver failure (ALF) is a devastating disease, and patients are at a higher risk of death without liver transplantation. Indicators are needed to identify the risk of death in ALF, which will help in the timely referral of patients to specialized centers. Clichy criteria and Kings College Hospital (KCH) criteria are the most widely used prognostic criteria. Real-life application of Clichy criteria is limited due to the non-availability of factor V level measurement. KCH criteria have good specificity but low sensitivity to predict outcomes. Therefore, we attempted to use the model for end-stage liver disease (MELD) score and chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score in ALF patients as prognostic indicators and need for liver transplantation. […] In our study, we used MELD score and CLIF-SOFA as prognostic markers, and we concluded that CLIF-SOFA is a better predictor of mortality than MELD score in terms of sensitivity, specificity, NPV, PPV, and diagnostic accuracy. AUROC for CLIF-SOFA score is higher when compared to the MELD score.

• #2 Incorporating dynamics for predicting poor outcome in acute liver failure patients

  https://www.wjgnet.com/1948-9366/full/v4/i12/281.htm

  Acute liver failure (ALF), also known as fulminant hepatic failure (FHF), is a devastating clinical syndrome with a high mortality of 60%-90%. An early and exact assessment of the severity of ALF together with prediction of its further development is critical in order to determine the further management of the patient. […] A number of prognostic models have been used for outcome prediction in ALF patients but they are mostly based on the variables measured at one time point, mostly at admission. […] Since ALF is a dynamic process, admission values of prognostic variables change over time during the clinical course of the patient. […] The timely prediction of spontaneous recovery helps to prevent LT and also the need for lifelong immunosuppressive therapy. Predicting whether the patient with ALF will require LT or will survive by only intensive medical care remains, however, challenging.

• #3 Prediction of Poor Outcome in Patients with Acute Liver Failure—Systematic Review of Prediction Models | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0050952

  Acute liver failure is a rare disease with high mortality and liver transplantation is the only life saving therapy. Accurate prognosis of ALF is crucial for proper intervention. […] The timely prediction of spontaneous recovery helps prevent LT and also the need for lifelong immunosuppressive therapy. Timely assessing the likelihood of mortality is important for decisions on emergency liver transplantation. […] The models have shown inconsistent reproducibility, prognostic accuracy and therefore cannot be taken to reliably predict mortality in ALF and the need for a better prognostic model remains. […] There are many studies on prognostic models for ALF but they show methodological and reporting limitations. Future studies could be improved by better reporting and handling of missing data, the inclusion of model calibration aspects, use of absolute risk measures, explicit considerations for variable selection, the use of a more extensive set of reference models and more thorough validation.

• #4 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

• #5 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

• #6 Prognostic Indicators for Acute Liver Failure Development and Mortality in Patients with Hepatitis A: Consecutive Case Analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4075399/

  Due to the seroepidemiological shift in hepatitis A (HA), its severity, mortality, and complications have increased in recent years. Thus, the aim of this study was to identify predictive factors associated with poor prognosis among patients with HA. […] The mean age of patients (204 males, 100 females) was 32 years. Eighteen (5.9%) patients had progressed to ALF. Of the patients with ALF, 10 patients (3.3%) showed spontaneous survival while 8 (2.6%) died or underwent liver transplantation. Multivariate regression analysis showed that Model for End-Stage Liver Disease (MELD) and systemic inflammatory response syndrome (SIRS) scores were significant predictive factors of ALF. […] MELD and SIRS scores 23.5 and 3, respectively, appeared to be related to ALF development. In addition, KCC and SIRS scores 3 were valuable in predicting mortality of patients with a MELD 23.5.

• #7 Prognostic Indicators for Acute Liver Failure Development and Mortality in Patients with Hepatitis A: Consecutive Case Analysis

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4075399/

  The MELD score was a powerful tool for predicting ALF development in patients with HA compared to DM, ALT, albumin, RDW 13.5, and the SIRS score. […] To cure more HA-related ALF patients, early liver transplantation is important, and prognostic factors for the prediction of ALF development are needed. In our study, higher MELD (23.5) and SIRS (3) scores appeared to be related to the development of ALF in patients with HA. Furthermore, in patients with a higher MELD score (23.5), those with a SIRS score 3 and who fulfilled KCC may need urgent liver transplantation.

• #8 Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure | eGastroenterology

  https://egastroenterology.bmj.com/content/2/3/e100101

  The model for end-stage liver disease (MELD) score is widely used for the prognostication in end-stage liver disease but has limited performance in acute-on-chronic liver failure (ACLF). […] CATCH-LIFE-MELD score, a modified MELD score exhibited improved accuracy in predicting the short-term prognosis of ACLF than other traditional scores. […] Patients with acute-on-chronic liver failure (ACLF) are at high-risk mortality, and accurate prediction of short-term outcomes is crucial for managing patients with ACLF. […] The model for end-stage liver disease (MELD) score is extensively used for the prognostic evaluation of ACLF, yet its efficacy is constrained. […] CATCH-LIFE-MELD score can be used for predicting and stratifying the risk of death in patients with ACLF, providing direction for future research on new therapeutic approaches. […] The new CATCH-LIFE-MELD score performed better than other traditional scores for ACLF.

• #9

  https://www.xiahepublishing.com/m/2310-8819/JCTH-2024-00316

  The MELD-complication score integrates laboratory values and essential clinical complications, thereby enhancing the prediction of short-term outcomes for ACLF patients. […] The MELD-complication score can be used to stratify mortality risk among ACLF patients, effectively identify high-risk individuals, and demonstrate robustness in two external cohorts, with distinct ACLF etiologies. […] This new model, which integrates the MELD score with significant complications and indicators of systemic inflammatory response, demonstrated superior predictive accuracy for short-term mortality compared to traditional scores such as MELD, MELD 3.0, and ALBI.

• #10 Acute Liver Failure Prognostic Criteria: It’s Time to Revisit

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9929612/

  Patients who did not survive had higher INR, MELD, CLIF-SOFA scores, and hepatic encephalopathy (HE) grades. Five patients who had a combination of MELD 30 and CLIF-SOFA 10, expired. […] The mortality rate in the study population was 37.5%. patients who did not survive had higher INR, HE grades, MELD scores, and CLIF-SOFA scores. […] Hepatic encephalopathy was found to be a predictor of mortality in various studies. […] CLIF-SOFA score correlates best with the final outcome of the patients having ALF as demonstrated by various literature all over the world.

• #11 Pediatric chronic liver failure-sequential organ failure assessment score and outcome of acute liver failure in children

  https://www.termedia.pl/Pediatric-chronic-liver-failure-sequential-organ-failure-assessment-score-and-outcome-of-acute-liver-failure-in-children,80,41821,1,1.html

  On admission, pCLIF-SOFA score of the non-survival group (11 [7-13]) was significantly higher than that of the survival group (8 [7-11]). […] Both pCLIF-SOFA and PELD/MELD scores, on admission, at cut-off values 8 and 30, respectively, could predict death in children with ALF with higher AUC for pCLIF-SOFA score (0.88, 95% CI: 0.74-0.96, p0.001) than that of PELD/MELD score (0.76, 95% CI: 0.61-0.88,p = 0.001). […] In conclusion, the pCLIF-SOFA score is better than the PELD/MELD score as a predictor of death in PALF and can be used for accurate selection of children with ALF who are in a real need of LT.

• #12 Incorporating dynamics for predicting poor outcome in acute liver failure patients

  https://www.wjgnet.com/1948-9366/full/v4/i12/281.htm

  Acute liver failure (ALF), also known as fulminant hepatic failure (FHF), is a devastating clinical syndrome with a high mortality of 60%-90%. An early and exact assessment of the severity of ALF together with prediction of its further development is critical in order to determine the further management of the patient. […] A number of prognostic models have been used for outcome prediction in ALF patients but they are mostly based on the variables measured at one time point, mostly at admission. […] Since ALF is a dynamic process, admission values of prognostic variables change over time during the clinical course of the patient. […] The timely prediction of spontaneous recovery helps to prevent LT and also the need for lifelong immunosuppressive therapy. Predicting whether the patient with ALF will require LT or will survive by only intensive medical care remains, however, challenging.

• #13 Incorporating dynamics for predicting poor outcome in acute liver failure patients

  https://www.wjgnet.com/1948-9366/full/v4/i12/281.htm

  A number of prognostic models have been used for outcome prediction in ALF patients to select patients in need for LT. […] The models have shown inconsistent reproducibility of prognostic accuracy, and the need for a better prognostic model remains. […] The authors found that early changes of prognostic markers predict outcome better than the static baseline levels. […] This observation is supported by the systematic review of Minne et al that underlined the association between the dynamics of the Sequential Organ Failure Assessment score with hospital mortality in the intensive care. […] The ALFED model was also compared with the established prognostic models KCC and MELD. The results of this comparison showed that performance of MELD and KCC criteria was inferior to the ALFED model in the two cohorts, although no statistical testing was attempted for comparison. […] Based on our above considerations we conclude that ALFED is a well constructed and well reported model which seems to be worthwhile to test in ALF patients in other parts of the world with different aetiologies.

• #14 Acute-on-chronic liver failure: an update | Gut

  https://gut.bmj.com/content/66/3/541

  The majority of patients achieved their final grade of ACLF within the first week; therefore, the assessment of ACLF grade at days 3-7 after diagnosis predicted 28-day and 90-day mortality more accurately than ACLF grade at diagnosis. […] CLIF-C ACLF score showed a significantly higher predictive accuracy than MELD, MELD-Na and Child-Pugh-Turcotte score at all main time points after ACLF diagnosis (28, 90, 180 and 365 days).

• #15 Acute-on-chronic liver failure: an update | Gut

  https://gut.bmj.com/content/66/3/541

  Acute-on-chronic liver failure (ACLF) is a syndrome characterised by acute decompensation of chronic liver disease associated with organ failures and high short-term mortality. […] Using a liver-adapted sequential organ assessment failure score, it is possible to triage and prognosticate the outcome of patients with ACLF. […] Most of the patients will have a clear prognosis between day 3 and 7 of hospital admission and clinical decisions such as evaluation for liver transplant or discussion over goals of care could be tailored using clinical scores. […] ACLF grade at diagnosis is associated with short-term prognosis, with patients with ACLF grade 3 showing the worst prognosis compared with that of patients with ACLF grade 1 and 2. […] Data from the CANONIC study showed overall 28-day mortality of 33% of all cases of ACLF, and specific 28-day mortality rates in patients with ACLF grade 1, 2 and 3 was 22%, 32% and 73%, respectively.

• #16 A Dynamic Model for Predicting Outcome in Patients with HBV Related Acute-On-Chronic Liver Failure | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-a-dynamic-model-for-predicting-S1665268119301942

  A Dynamic Model for Predicting Outcome in Patients with HBV Related Acute-On-Chronic Liver Failure […] Introduction and aim. Accurately predicting the prognosis of individual patient is crucial in the management of ACLF. We aimed to establish a specific prognostic model for HBV-related ACLF patients treated with nucleoside analog (NA). […] Results. The area under receiver operating characteristic curve (AUC) of the model for predicting 90-day mortality was 0.86, which was significantly higher than that of model for end stage liver disease(MELD), MELD-Na, CLIF-SOFA, MELD (7d) and MELD-Na (7d), ACLIF- SOFA(7d) (all p 0.01). The AUC of our model in the validation group was 0.79 which was superior to MELD (0.45) CLIF-SOFA (0.53) score in group B patients (p 0.01). […] Conclusion. In conclusion, the model was superior to the conventional methods in predicting the outcomes of patients with HBV related ACLF treated with NA. It is the first description of a novel prognostic model using consecutive data in patients with HBV-induced acute-on-chronic liver failure (ACLF) treated by nucleoside analogs.

• #17

  https://journals.lww.com/ccejournal/fulltext/2024/02000/liver_elastography_in_acute_liver_failure__a_pilot.10.aspx

  In this pilot study, we showed that elastography has the potential to be used in acute liver failure and prognosticate outcome on day 7 of admission. […] The current transplant criteria identify ALF patients with poor prognosis with 58% sensitivity and 89% specificity thus there is an urgent need for new bedside tools to aid in prognostication. […] However, the trend during the first 10 days of admission was different between the two groups. LSM peaked at day 5 in spontaneous survivors with subsequent reduction during the recovery phase. In contrast, patients with a poor prognosis exhibited persistently increased LSM, and by day 7 of admission, the two groups displayed statistically different LSM values. […] We also calculated a ratio between day 7 LSM and baseline, which showed a trend, although not statistically significant, of increment in patients with a poor prognosis. […] Further studies, in a larger cohort, are needed to better understand the diagnostic role of liver stiffness in acute liver failure and whether the addition of these values to existing prognostic criteria could improve their sensitivity and specificity.

• #18

  https://journals.lww.com/ccejournal/fulltext/2024/02000/liver_elastography_in_acute_liver_failure__a_pilot.10.aspx

  We aimed to assess the feasibility and reliability of sequential ultrasonographic and elastographic monitoring in acute liver failure (ALF). […] At admission, liver stiffness measurement (LSM) of the right lobe was statistically different between HC individuals (5.62 kPa), ALF (31.717 kPa), and ACLF (76.371 kPa) patients (ALF vs. ACLF, p = 0.0301). […] At admission, LSM was not different between ALF patients who spontaneously survived versus patients who died or were transplanted in the following 90 days. However, the trend over the first 10 days of admission was different with a peak of LSM at day 5 in spontaneous survivors followed by reduction during the recovery phase. ALF patients with poor prognosis showed a persistently increased LSM. […] In ALF stiffness peaks at day 5 of admission with subsequent reduction in patients spontaneously surviving, showing significant difference according to the prognosis at day 7 of admission. LSM might be useful in distinguishing acute from acute-on-chronic liver failure together with spleen volume and stiffness.

• #19 Predicting Outcome on Admission and Post-Admission for Acetaminophen-Induced Acute Liver Failure Using Classification and Regression Tree Models | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122929

  Assessing prognosis for acetaminophen-induced acute liver failure (APAP-ALF) patients often presents significant challenges. […] We aimed to improve determinations of prognosis both at the time of and following admission for APAP-ALF using Classification and Regression Tree (CART) models. […] CARTs offer simple prognostic models for APAP-ALF patients, which have higher AUROC and SN than KCC, with similar AC and negligibly worse SP. Admission and post-admission predictions were developed. […] Prognostication in acetaminophen-induced acute liver failure (APAP-ALF) is challenging beyond admission. […] Little has been published regarding the use of Kings College Criteria (KCC) beyond admission and KCC has shown limited sensitivity in subsequent studies. […] Data from the ALFSG registry suggested that CART prognosis models for the APAP population offer improved sensitivity and model performance over traditional regression-based KCC, while maintaining similar accuracy and negligibly worse specificity.

• #20 Predicting Outcome on Admission and Post-Admission for Acetaminophen-Induced Acute Liver Failure Using Classification and Regression Tree Models | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0122929

  KCC-CART models offered modest improvement over traditional KCC, with NEW-CART models performing better than KCC-CART particularly at late time points. […] In this analysis, CART models modestly increased predictive performance of 21-day death/LT compared to traditional regression-derived KCC using United States ALFSG data. […] KCC-CART trees improved considerably the sensitivity and AUROC and provided similar predictive accuracy compared to traditional KCC, while NEW-CART models provide further but marginal improvement over KCC-CART models on admission. […] A limitation of the post-admission KCC-CART model was that it used creatinine without considering whether or not patients were on RRT. Therefore, the post-admission NEW-CART model may be preferable for prediction compared to the KCC-CART. […] In summary, both KCC-CART and NEW-CART models have benefits and could be used in predicting death/LT of new APAP-ALF patients for admission and post-admission.

• #21 Predicting the prognosis in acute liver failure: results from a retrospective pilot study using the LiMAx test | Annals of Hepatology

  https://www.elsevier.es/en-revista-annals-hepatology-16-articulo-predicting-prognosis-in-acute-liver-S1665268119313390

  Predicting the prognosis in acute liver failure: results from a retrospective pilot study using the LiMAx test […] To evaluate maximal liver function capacity (LiMAx) for predicting the prognosis of ALF. […] Maximal liver function capacity determined by LiMAx test is severely impaired in patients with ALF. The LiMAx test might be effective in predicting the individual prognosis and the need for LTX in ALF. […] The present pilot study presents for the first time the clinical significance of the maximal liver function capacity in ALF. It is shown that the LiMAx test cannot only determine ALF itself, but can potentially differentiate between those patients with spontaneous recovery and those that require urgent listing for LTX. […] The detailed case reports show the potential application of the LiMAx test in patients with ALF. The definite advantage of the LiMAx test is its sensitivity for short-term changes that cannot be provided by any biochemical test. […] In conclusion, maximal liver function capacity determined by the LiMAx test is markedly impaired in patients with ALF. The extent of functional impairment might be a very valuable parameter for predicting the individual prognosis and the need for LTX.

• #22

  https://link.springer.com/article/10.1007/s12072-022-10363-2

  Acute-on-chronic liver failure (ACLF) is characterized by the development of a syndrome associated with a high risk of short-term death in patients with acute decompensated cirrhosis, and better indicators are needed to predict such outcomes. […] Sarcopenia was an independent risk factor for progression in the ACLF population (HR 3.771 95% CI 2.114-6.727, p<0.001). [...] We demonstrate that sarcopenia is a simple and objective indicator for predicting short-term prognosis in patients with ACLF. [...] AMPAS1 was a good predictor, with an area under the ROC curve of 0.865, and the cut-off value for poor outcome prediction was 0.31 (sensitivity 79.4%, specificity 76.4%). [...] Our analyses of a cohort of patients with ACLF revealed three major findings. First, to our knowledge, this is the first study to report sarcopenia as an independent risk factor for progression in an ACLF population.

• #23

  https://link.springer.com/article/10.1007/s12072-022-10363-2

  Our new model, AMPAS1, was a good predictor of such outcomes. […] The present study indicates that sarcopenia is a simple and objective indicator that can predict the 90 day prognosis of patients with ACLF. […] AMPAS1 is a better model to predict 90 day adverse outcomes in patients with ACLF than the conventional prognostic scores.

• #24 Epidemiology of acute liver failure in Egyptian children | Egyptian Liver Journal | Full Text

  https://eglj.springeropen.com/articles/10.1186/s43066-024-00346-3

  The study included 154 patients who fulfilled the definition of ALF were included. Their age ranged from 7 months to 17 years, with a median of 5.8 years. Mortality was the outcome for 73 patients (47.4%). The prognostic factors associated with mortality were elevated international normalized ratio (INR), total bilirubin (TB), creatinine, and ammonia levels at presentation with cutoff values (2.97, 21.15, 0.385, and 212, respectively). […] The mortality rate is high, and most of the deaths occurred early in the first 5 days of admission. So, early preparation for liver transplantation is recommended. Higher values of INR, TB, and creatinine above the cutoff levels at presentation may be potential markers for predicting death in affected children. […] The high mortality rate in the first 5 days of admission may be due to the inability to identify the etiology in undiagnosed cases in addition to a lack of awareness about the disease and delayed reference of cases.

• #25

  https://www.xiahepublishing.com/m/2310-8819/JCTH-2024-00316

  Early determination of prognosis in patients with acute-on-chronic liver failure (ACLF) is crucial for optimizing treatment options and liver allocation. […] The study included 1,386 ACLF patients and identified six independent predictors of 28-day mortality through multivariate analysis (all p<0.05). [...] This study presents a refined prognostic model, the Model for end-stage liver disease-complication score, which accurately predicts short-term mortality in ACLF patients. [...] The survival curve showed that as the number of complications increased, the survival rate of patients decreased significantly. [...] The results of the multivariate analysis revealed that HE, pulmonary infection, and SBP were independent risk factors for short-term mortality and were indeed the most important complications for short-term mortality.

• #26 Acute Liver Failure: Practice Essentials, Background, Pathophysiology

  https://emedicine.medscape.com/article/177354-overview

• #27 Clinical profile and outcome among patients with acute-on-chronic liver failure admitted in the intensive care unit | The Egyptian Journal of Internal Medicine | Full Text

  https://ejim.springeropen.com/articles/10.1186/s43162-021-00061-0

  Acute-on-chronic liver failure (ACLF) has been recently defined as a clinical form including acute hepatic decompensation and high 28-day mortality. […] CLIF-C ACLF is assumed to be a highly prognostic score for mortality in ACLF patients better than other scores. […] There is a significant difference between the 3 ACLF groups regarding 1-month and 3-month mortalities in patients admitted to the ICU. […] Mortality is high in ACLF and increases with the number of organ failures (40% in ACLF1 to 100% in ACLF3). […] CLIFC-ACLF is the most prognostic scoring system with a cut-off value of 57; above this value, mortality is a fact. […] Prognosis is associated with types and number of failed organs and this can be measured by the chronic liver failure (CLIF) organ failure (CLIF-OF) score.

• #28 Clinical profile and outcome among patients with acute-on-chronic liver failure admitted in the intensive care unit | The Egyptian Journal of Internal Medicine | Full Text

  https://ejim.springeropen.com/articles/10.1186/s43162-021-00061-0

  The survival is considered zero in patients with a CLIF-C ACLF score 64 without urgent liver transplant. […] CLIF-C ACLF is assumed to be a highly prognostic score as regards mortality in ACLF patients as compared to other scores. […] Our study concluded an algorithm to stratify patients according to prognosis is needed, in order to monitor treatment responsiveness, determine emergency for transplantation, and decide allocation in the intensive care unit (ICU) and also to have a rational basis to decide futility. […] We found that CLIF-C ACLF was the best prognostic model as regards mortality, whereas CTP, APACHE, MELD, MELD Na+, and SOFA scores were statistically non-significant. […] We studied CLIC-C ACLF score ROC curve (AUC) = 0.972 with CI: 0.919, 1.025, cutoff point = 57 above which intensive care admission does not seem to benefit ACLF patients. […] Mortality is high in ACLF and increases with the number of organ failures (40% in ACLF1 to 100% in ACLF3).

• #29 Prediction of Poor Outcome in Patients with Acute Liver Failure—Systematic Review of Prediction Models | PLOS One

  https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0050952

  In this review we identified, summarized and assessed the quality of available models in the literature for prediction of poor outcome in adult patients with ALF. […] Model development usually relied on regression analysis, including logistic, linear or Cox regression. The models were usually constructed from clinical and/or demographic data to predict mortality or survival, only four studies used the combined outcome of death and transplantation. […] However, half of the studies included small samples (100 patients) and performed no internal, temporal or external validation. None of the studies reported on how well the model was calibrated. […] This systematic review provides an overview of models for prediction of poor outcome in patients with acute liver failure. These prognostic models were developed to support clinicians’ decisions, but they should be improved before being clinically useful. Future studies could be improved by paying more attention to (internal) validation, the inclusion of model calibration aspects, better consideration of the transplantation patient group, better reporting and handling of missing data, use of absolute risk measures, explicit considerations for considering and selecting predictors, the use of a more extensive set of reference models, and the inclusion of continuous variables without categorizing them, as well as clear reporting on the study design.

• #30 Pediatric chronic liver failure-sequential organ failure assessment score and outcome of acute liver failure in children

  https://www.termedia.pl/Pediatric-chronic-liver-failure-sequential-organ-failure-assessment-score-and-outcome-of-acute-liver-failure-in-children,80,41821,1,1.html

  Acute liver failure (ALF) in children is a dramatic clinical syndrome characterized by deterioration in liver function tests, and potentially associated with dysfunction in other organs. […] Despite new therapies and support measures, survival continues to be unsatisfactory, ranging between 10% and 40%. After the introduction of LT as a therapeutic option for patients with ALF, the survival rate reached 60% to 80%. […] When to list a child is critical for the success of LT, knowledge of sensitive prognostic markers could also determine whether there is a possibility of recovery without LT. […] The ideal prognostic model remains elusive, as none of the currently used models could perform extremely well. […] The aim of the present study was to investigate the prognostic accuracy of the pediatric chronic liver failure sequential organ failure assessment (pCLIF-SOFA) score in comparison to the Pediatric End-Stage Liver Disease (PELD)/MELD score in children with ALF admitted to our tertiary center.

• #31 Comparing Eight Prognostic Scores in Predicting Mortality of Patients with Acute-On-Chronic Liver Failure Who Were Admitted to an ICU: A Single-Center Experience

  https://www.mdpi.com/2077-0383/9/5/1540

  The results showed that APACHE III and CLIF-C ACLF scores were significantly superior to other models in predicting overall mortality as determined by time-dependent ROC curve analysis (AUROC: 0.817). […] In predicting the 28-day mortality, APACHE III showed no significant difference to CLIF-C OF, CLIF-C ACLF, and MELD. However, they were all statistically superior to MPM0-III and SAPs III. […] Therefore, from a research perspective, it is an interesting finding that APACHE III performed as well as CLIF-C ACLF based on ICU admission day data in predicting overall and other time-point mortality for those patients with ACLF admitted to the ICU. […] Further prospective study is warranted to assess the value of these scores for better liver transplantation priority assessment.

• #32 The Role of Predictive Models in the Assessment of the Poor Outcomes in Pediatric Acute Liver Failure

  https://www.mdpi.com/2077-0383/11/2/432

  The predictive models are based on features derived from analysis of ALF cohorts, treated conservatively, without LT. […] There is no predictive model universally accepted for evaluating ALF outcomes in children, and all are based upon data and experiences in adults. […] An ideal predictive model in ALF will help us to be sure that all children needing an LT will receive it (higher sensitivity and positive predictive value, PPV), and those who would survive without LT would not have it (higher specificity and negative predictive value, NPV). […] Our study aimed to analyze PELD/MELD scores and KCC’s role in predicting the survival with native liver in children with ALF of different etiologies. […] The PELD score was significantly higher in patients with poor outcomes than survivors.

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