title: Performance of scoring systems to predict mortality of patients with acute-on-chronic liver failure: A systematic review and meta-analysis.
abstract: OBJECTIVE
  Acute-on-chronic liver failure (ACLF) has characteristic feature of multisystem organ failure, rapid progression, and low early transplant-free survival. We performed a meta-analysis to determine the accuracy of five scoring systems in predicting mortality of ACLF patients.
  
  
  METHODS
  A systematic database search was performed, and retrieved articles were graded according to methodological quality. Collated data was meta-analyzed by hierarchical summarized receiver operating characteristic model and bivariate model to evaluate the diagnostic accuracy of scoring systems.
  
  
  RESULTS
  Of 4223 studies identified, 26 studies involving 4732 ACLF patients were included. The model of end-stage liver disease (MELD) score was found to have largest the area under summarized receiver operating characteristic (AUROC) (0.82) compared with other estimated scoring systems, especially for 3-month mortality. MELD serum sodium (MELD-Na) score showed homologous high accuracy, with the AUROC was 0.81. However, meta-analyses of 16 studies showed that Child-Pugh-Turcotte score had least AUROC (0.71). Sequential organ failure assessment (SOFA) score presented moderately lower diagnostic accuracy, with AUROC being 0.73. Moreover, chronic liver failure-SOFA score presented excellent accuracy of prognostication with highest diagnostic odds ratios.
  
  
  CONCLUSIONS
  This review demonstrated that MELD had moderate diagnostic accuracy to predict mortality of ACLF patients. Considering the expectative diagnostic value, chronic liver failure-SOFA could be regarded as a promising replacement of MELD. To improve the predictive power of scoring systems, multicenter prospective studies of large sample sizes with long-term follow-up are needed.
authors.affiliation: Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Yi-Xiang
authors.initials: YX
authors.lastname: Zheng
authors.affiliation: Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Xiao
authors.initials: X
authors.lastname: Zhong
authors.affiliation: Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Ya-Jun
authors.initials: YJ
authors.lastname: Li
authors.affiliation: Department of Infectious Diseases, Key Laboratory of Viral Hepatitis of Hunan, Xiangya Hospital, Central South University, Changsha, China.
authors.forename: Xue-Gong
authors.initials: XG
authors.lastname: Fan
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis* / Q000401:mortality*; D016206:Databases, Bibliographic; D006801:Humans; D015233:Models, Statistical; D063305:Organ Dysfunction Scores; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve
keywords: acute-on-chronic liver failure; hepatology; liver transplantation; meta-analysis