Clin Mol Hepatol.
2024 Jul;30(3):388-405. 10.3350/cmh.2023.0563.
Dynamic analysis of acute deterioration in chronic liver disease patients using modified quick sequential organ failure assessment
- Affiliations
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- 1Department of Internal Medicine, St. Vincent’s Hospital, The Catholic University of Korea, Seoul, Korea
- 2Department of Internal Medicine, Uijeongbu St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
- 3Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
- 4Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
- 5Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Korea
- 6Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
- 7Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea
- 8Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Korea
- 9Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Korea
- 10Department of Internal Medicine, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea
- 11Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
- KMID: 2557391
- DOI: http://doi.org/10.3350/cmh.2023.0563
Abstract
- Background/Aims
Quick sequential organ failure assessment (qSOFA) is believed to identify patients at risk of poor outcomes in those with suspected infection. We aimed to evaluate the ability of modified qSOFA (m-qSOFA) to identify high-risk patients among those with acutely deteriorated chronic liver disease (CLD), especially those with acute-onchronic liver failure (ACLF).
Methods
We used data from both the Korean Acute-on-Chronic Liver Failure (KACLiF) and the Asian Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) cohorts. qSOFA was modified by replacing the Glasgow Coma Scale with hepatic encephalopathy, and an m-qSOFA ≥2 was considered high.
Results
Patients with high m-qSOFA had a significantly lower 1-month transplant-free survival (TFS) in both cohorts and higher organ failure development in KACLiF than those with low m-qSOFA (Ps<0.05). Subgroup analysis by ACLF showed that patients with high m-qSOFA had lower TFS than those with low m-qSOFA. m-qSOFA was an independent prognostic factor (hazard ratios, HR=2.604, 95% confidence interval, CI 1.353–5.013, P=0.004 in KACLiF and HR=1.904, 95% CI 1.484– 2.442, P<0.001 in AARC). The patients with low m-qSOFA at baseline but high m-qSOFA on day 7 had a significantly lower 1-month TFS than those with high m-qSOFA at baseline but low m-qSOFA on day 7 (52.6% vs. 89.4%, P<0.001 in KACLiF and 26.9% vs. 61.5%, P<0.001 in AARC).
Conclusions
Baseline and dynamic changes in m-qSOFA may identify patients with a high risk of developing organ failure and short-term mortality among CLD patients with acute deterioration.
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