title: Predictive formula for acute liver failure is useful for predicting the prognosis of patients with acute-on-chronic liver failure.
abstract: OBJECTIVE
  The prognosis of acute-on-chronic liver failure (ACLF) is extremely poor in comparison to acute liver failure (ALF). We aimed to establish methods for the early diagnosis of ACLF and its severity to identify the patients with a poor prognosis.
  
  
  METHODS
  The laboratory data at admission of 30 ACLF and 46 ALF patients were compared. Three established prognosis prediction models (Model for End-Stage Liver Disease [MELD]; MELD modified by serum sodium concentration, [MELD-Na]; and the Japan hepatic encephalopathy prediction model [J-HEPM]) were assessed using area under the receiver-operator curve (AUROC) values.
  
  
  RESULTS
  No significant difference was found in the laboratory data of the two patient groups. J-HEPM was able to predict the outcome of the ACLF subjects (AUROC = 0.93).
  
  
  CONCLUSIONS
  Although ACLF could not be differentially diagnosed from ALF at admission from the laboratory data alone, the J-HEPM effectively predicted the prognosis of liver failure in patients with ACLF. These findings indicate that ACLF patients with high J-HEPM scores require earlier and more intensive care than ALF patients.
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Keisuke
authors.initials: K
authors.lastname: Kakisaka
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Kojiro
authors.initials: K
authors.lastname: Kataoka
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Hidekatsu
authors.initials: H
authors.lastname: Kuroda
authors.affiliation: Division of Hepatology, Department of Internal Medicine, Iwate Medical University, Morioka, Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Takikawa
keywords: acute liver failure; acute-on-chronic liver failure; hepatic encephalopathy prediction model