Chinese Hepatolgy ›› 2023, Vol. 28 ›› Issue (1): 41-45.

• Liver Failure • Previous Articles     Next Articles

Predictive value of COSSH-ACLFⅡ score for short-term prognosis in patients with acute-on-chronic liver failure

SHEN Zhou-ming1, 3, CHEN Wei-jie1, LIU Yi-cun1, ZHANG Li1, XUE Hong2, BIAN Zhao-lian3   

  1. 1. Nantong University Medical School, Jiangsu 226001, China;
    2. Department of Liver Diseases,Nantong Third Hospital Affiliated to Nantong University/Nantong Third People's Hospital, Jiangsu 226001, China;
    3. Department of Gastroenterology, Nantong Third Hospital Affiliated to Nantong University/Nantong Third People's Hospital, Jiangsu 226001, China
  • Received:2022-10-25 Online:2023-01-31 Published:2023-02-21

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Abstract: Objective To investigate the predictive value of COSSH-ACLFⅡ score in the short-term prognosis of patients with acute-on-chronic liver failure (ACLF). Methods A total of 73 patients with ACLF admitted to our hospital from January 2020 to January 2022 were collected, they were divided into survival group and death group according to the survival status during the 90-day follow-up. The χ2 test was used to compare the enumeration data between the 2 groups. The t test or the Mann-Whitney U test was used to compare the measurement data between the 2 groups. The clinical data between the 2 groups were compared, and the receiver operating characteristic (ROC) curve was used to analyze the clinical efficacy of COSSH-ACLFⅡ, MELD, MELD-Na, iMELD and CTP scores in predicting the prognosis of patients with ACLF, and the optimal cutoff of COSSH-ACLFⅡ score was calculated. The Kaplan-Meier method was used to draw survival curves. Results There were significant differences in age (50.84 ± 12.49 vs 63.00 ± 12.47, t=-3.910, P＜0.01), hepatic encephalopathy (16.33% vs 37.50%, χ2=4.043, P=0.044), gastrointestinal bleeding (6.22% vs 41.67%, χ2=11.583, P＜0.01), total bilirubin [229.10 (113.80,363.40) vs 294.45 (241.88,366.30), U=-2.243, P=0.025], international normalized ratio (1.67±0.49 vs 1.94 ± 0.56, t=-2.117, P=0.038), serum creatinine (64.14 ± 18.20 vs 94.51±40.60, t=-3.497, P=0.020) and blood urea nitrogen [4.68 (3.12,6.55) vs 6.82 (4.05,10.44), U=-2.178, P=0.029] between the survival group and the death group (P<0.05). The COSSH-ACLFⅡ (6.58 ± 0.95 vs 7.78 ± 0.86, t=-5.238, P＜0.01), MELD (20.46 ± 6.52 vs 24.28 ± 3.76, t=-2.653, P＜0.01), MELD-Na (21.40 ± 9.45 vs 26.15 ± 8.01, t=-2.120, P=0.038), iMELD (40.73 ± 8.64 vs 51.81 ± 14.92, t=-4.019, P＜0.01) and CTP (10.00 ± 1.74 vs 11.00 ± 1.47, t=-2.416, P=0.018) scores in the death group were higher than those in the survival group, and the differences were statistically significant (P<0.05). The ROC curve analysis showed that the area under the curve (AUC) of different scoring systems for predicting acute-on-chronic liver failure were: COSSH-ACLFII (AUC = 0.826,95% CI: 0.727~0.925), MELD (AUC = 0.688, 95% CI: 0.565~0.811), iMELD (AUC = 0.765, 95% CI: 0.684~0.882), MELD-Na (AUC = 0.651, 95% CI: 0.521~0.780) and CTP score (AUC=0.640,95% CI: 0.504~0.775). The AUC of the COSSH-ACLFIIs model was higher than that of other models. The optimal cutoff value of COSSH-ACLFII was determined by the Youden index at 7.02, Kaplan-Meier analysis showed that the cumulative survival rate of patients in COSSH-ACLFⅡ > 7.02 group was significantly lower than that in COSSH-ACLFⅡ ≤ 7.02 group, Log-Rank=19.97, and the difference was statistically significant (P<0.0001).Conclusion The COSSH-ACLFⅡ score model performs better than MELD score, MELD-Nascore, iMELD score and CTP score in predicting the short-term survival rate of patients with ACLF. COSSH-ACLFⅡ > 7.02 indicates poor prognosis.

Key words: Scoring model, Acute on chronic liver failure, Short term, Prognosis