Simple organ failure count versus CANONIC grading system for predicting mortality in acute-on-chronic liver failure

Background and AimThis study assessed the utility of a simple organ failure count (SOFC) in predicting the in-hospital mortality in patients with acute-on-chronic liver failure (ACLF) compared with Chronic Liver Failure Acute-on-Chronic Liver Failure in Cirrhosis (CANONIC) ACLF grading system. MethodsConsecutive patients of ACLF were included prospectively from 2012 to 2013. The diagnosis was based on Asian-Pacific Association for the Study of the Liver (APASL) criteria except for the inclusion of non-hepatic insults as acute events. Organ failures were defined as per the Chronic Liver Failure-Sequential Organ Failure Assessment system. SOFC was calculated as the simple number of organ failures from 0 to 6. In-hospital mortality was recorded. ResultsMajority (92[87%]) of the 106 patients included were males, had alcohol (76[72%]) as the etiology of cirrhosis, and alcoholic hepatitis (58[55%]) as the acute precipitating event. Overall, 51(48%) patients died in-hospital. In-hospital mortality in patients with SOFC of 0 (n=9), 1 (n=39), 2 (n=24), 3 (n=24), 4 (n=7), and 5 (n=3) was 0%, 26%, 58%, 71%, 100%, and 100% respectively (P<0.001), whereas it was 10%, 30%, 58%, and 79% in patients with no-ACLF (n=21), grades 1 (n=27), 2 (n=24), and 3 ACLF (n=34) respectively (P<0.001). Patients with no-ACLF (n=21) had higher mortality than SOFC 0 as they included 9 patients with SOFC 0 (0% mortality) and 12 patients with SOFC 1 (17% mortality). Mortality was similar between 12 no-ACLF and 27 grade 1 ACLF patients (P=0.462) that comprised SOFC 1. ConclusionSOFC is a simpler and better method than the CANONIC grading system for predicting the in-hospital mortality in patients with ACLF defined as per APASL criteria.