| Dynamic Assessment of Modified Quick Sequential Organ Failure Assessment in Acutely Deteriorated Patients with Chronic Liver Disease |
| Do Seon Song1, Hee Yeon Kim2, Young Kul Jung3, Tae Hyung Kim3, Hyung Joon Yim3, Eileen L Yoon4, Ki Tae Suk5, Jeong-ju Yoo6, Sang Gyune Kim6, Moon Young Kim7, Young Chang8, Soung Won Jeong8, Jae Young Jang8, Sung-Eun Kim5, Jung-Hee Kim5, Jung Gil Park9, Won Kim10, Jin Mo Yang1, Dong Joon Kim5, Korean Acute-on-Chronic Liver Failure (KACLiF) study group, Ashok Kumar Choudhury11, Vinod Arora11, Shiv Kumar Sarin11, APASL ACLF Research Consortium (AARC) for APASL ACLF working party |
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 110070, India |
| Correspondence : |
Dong Joon Kim ,
Tel: +82 33 240 5646, Fax: +82 33 241 8064, Email: djkim@hallym.ac.kr
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Received: December 27, 2023 Revised: March 23, 2024 Accepted: April 9, 2024 |
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| ABSTRACT |
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Background/Aims
Quick sequential organ failure assessment (qSOFA) has been suggested to identify those who have poor outcomes in patients with suspected infection. We aimed to evaluate the ability of the modified qSOFA (m-qSOFA) to identify high-risk patients in acutely deteriorated patients with chronic liver disease (CLD), especially acute-on-chronic liver failure (ACLF).
Methods
We used the data of both Korean Acute-on-Chronic Liver Failure (KACLiF) and 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 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 patients with low m-qSOFA (Ps<0.05). Subgroup analysis by ACLF showed that patients with high m-qSOFA had lower TFS than patients 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 the 7th day had a significantly lower 1-month TFS than the patients with high m-qSOFA at baseline but low m-qSOFA on the 7th day (52.6% vs. 89.4%, P<0.001 in KACLiF and 26.9% vs. 61.5%, P<0.001 in AARC).
Conclusion
Baseline and dynamic changes in m-qSOFA were useful to identify patients with a high risk of organ failure development and short-term mortality among CLD patients with acute deterioration. |
| KeyWords:
qSOFA; Acute-on-chronic liver failure; organ failure; survival |
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