Assessment of chronic liver failure consortium-acute-on-chronic liver failure score in predicting response to treatment and mortality in Egyptian patients with acute hepatorenal syndrome

Acute decompensated cirrhosis and acute-on chronic liver failure (ACLF) are prevalent consequences in patients with advanced liver cirrhosis with significant morbidity & mortality. Acute hepatorenal syndrome secondary to acute kidney injury (HRS-AKI) is an integral component of all grades of ACLF. It has a rapid progressive course with universal fatal outcome without prompt & adequate management. ACLF The Chronic Liver Failure-Consortium Acute-on-Chronic Liver Failure (CLIF-C ACLF) score was recently validated to grade ACLF severity and to predict its prognosis. Our study enrolled 142 cirrhotic patients admitted to our ICU with HRS-AKI. The study cohort was divided into 2 groups (1 & 2) according to response to the standard treatment with IV albumin & terlipressin or norepinephrine. Our study revealed that 45% of HRS-AKI patients responded to the standard medical treatment. The overall 90-day mortality of our cohort was 71%, and the 90-day mortality of the responders was 36%. WBCs count, serum bilirubin level, serum creatinine level at admission, MELD & CLIF-C ACLF scores were the statistically significant predictors of response to treatment. CLIF-C ACLF score cutoff point (≥65 points) had a high statistically significant (p. <0.0001) capability for predicting 90-days mortality in our HRS-AKI patients. In conclusion, CLIF-C ACLF accurately predicts response to treatment & 90-day mortality in patients with HRS-AKI secondary to decompensated liver cirrhosis.