title: Simple organ failure count versus CANONIC grading system for predicting mortality in acute-on-chronic liver failure.
abstract: OBJECTIVE
  This 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.
  
  
  METHODS
  Consecutive 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.
  
  
  RESULTS
  Majority (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.
  
  
  CONCLUSIONS
  SOFC 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.
authors.affiliation: Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
authors.forename: Swastik
authors.initials: S
authors.lastname: Agrawal
authors.forename: Ajay
authors.initials: A
authors.lastname: Duseja
authors.forename: Tarana
authors.initials: T
authors.lastname: Gupta
authors.forename: Radha K
authors.initials: RK
authors.lastname: Dhiman
authors.forename: Yogesh
authors.initials: Y
authors.lastname: Chawla
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis* / Q000401:mortality*; D000328:Adult; D058625:End Stage Liver Disease / Q000175:diagnosis* / Q000401:mortality*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality; D008111:Liver Function Tests / Q000379:methods*; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index
keywords: ACLF; acute decompensation; cirrhosis; mortality; organ failure; prognosis