P2348 - Simplified Prognostic Model for Predicting First 15 Days Mortality in Alcoholic Acute on Chronic Liver Failure Patients

Monday, October 23, 2023

10:30 AM – 4:15 PM PT

Location: Exhibit Hall

Has Audio

Presenting Author(s)

Sunil Kumar Dadhich, MD, PhD, FACG

SN Medical College
Jodhpur, Rajasthan, India

Vivek Saini, MD, Sunil Kumar Dadhich, MD, PhD, FACG, Narendra Bhargava, MD, Sabir Hussain, MD, Sewaram Chaudhary, MD
SN Medical College, Jodhpur, Rajasthan, India

Introduction: ACLF is a dynamic and catastrophic illness with high short term mortality. While several studies have focused on prognosticating the 30- to 90-day mortality in ACLF, the early mortality within the first 15 days has received limited attention,although this period also contribute significant chunk of deaths. Hence we aim to evaluate the same in alcoholic ACLF patients.

Methods: Clinical and biochemical blood parameters of 227 alcoholic ACLF patients were collected during a period of Jan2021-Feb 2023.These patients were followed up until either 90 days or death. Data points were collected at multiple time intervals at 0, 4, 7, 15, 30, 45, 60, and 90 days. Statistical analysis was performed focusing on 15 day mortality and comparing with those who survived beyond 15 days.

Results: Of 227 patients, 27% (62) died within7 days, 41% (94) within 15 days, 53% (121) within 30 days and 60% (136) within 90 days while 40% (91) survived beyond 90 days. Comparison of baseline means of 15 day mortality versus survived showed statistically significant difference in daily alcohol intake ( 198g v 144g, p=.01), serum creatinine (2.2 v 1.6, p-0.04), lactate (2.8 v 1.8, p<0.00), neutrophil counts (82% v 76%, p<0.00), MELDNa score (33 v 30,p-0.005), AARC score (10.7 v 9.4,p< .00). Chi square test indicated significant association of SIRS, HE, NOF with mortality.

Uni-variant Cox regression revealed significant hazards ratio of lactate (p-.000,HR-1.91), creatinine (p-.003,HR-1.17), daily alcohol intake (p-.00, HR-1.003), neutrophils (p-.000,HR-1.052), NOF (p-000,HR-1.674), SIRS ( p-0.000,HR-10.6), AARC score (p-0.000,HR-1.251), MELDNa score (p-0.01,HR-1.037) on 15 day mortality. Multi-variant cox regression of categorical blood parameters showed that creatinine < 0.7 mg/dl had 56% less mortality (p-0.004, HR - 0.44) than creatinine >1.5mg/dl, INR < 1.8 had 53% less mortality (p-0.02,HR-0.47)than INR >1.8, lactate < 1.8 had 58% less mortality (p-< .00,HR-0.42) than lactate >1.8 and neutrophil counts < 80% had 57% less mortality (p-< 0.00, HR-0.43). Those consuming < 200g/day of alcohol had 70% less mortality to those with >300g/day.Among the prognostic scores, only AARC (score ≤ 7 v >10, p-0.03, HR-0.10) and SIRS (present v absent, p-< 0.00, HR-9.5) showed significant results.

Discussion: Conclusions: Patients with alcoholic ACLF have a high early 15 Day mortality and the SIRS, AARC score and daily amount of alcohol intake hold the key in prognosticating the same.

Figure: Figure: Decision Tree Analvsis of alcoholic ACLF

Compilation of Positive results
Independent T-Test
Variable	Means ± S.D			P value
	Mortality upto 15 Days		Survived beyond 15 Days
Creatinine	2.21		1.6	0.04
Lactate	2.8		1.8	0.00
Neutrophils %	82		76	0.00
Daily alcohol intake (g)	198		144	0.01
MELD Na	32		30	0.05
AARC score	10.7		9.4	0.00
Chi-Square Test
• Statistically significant relationship between SIRS and Event (Mortality within 15days v Survival beyond 15 Days), X2 (1) = 54.7, p =0 .00 • Statistically significant relationship between Number of Organ failure and Event (Mortality within 15days v Survival beyond 15 Days), X2 (3) = 23.93, p =0 .00
Univariate Cox Regression Analysis
		HR		P-Value
Lactate		1.91		< 0.05
Creatinine		1.17		0.003
Daily Alcohol Intake		1.003		< 0.05
Neutrophils		1.052		< 0.05
NOF		1.67		< 0.05
SIRS		10.6		< 0.05
AARC score		1.25		< 0.05
MELDNa score		1.04		0.01
Multivariate Cox Regression Analysis of Categorical Blood Parameters
Categorical Blood Parameters		HR		P value
Creatinine < 0.7mg/dl compared to creatinine >1.5mg/dl		0.44		0.004
INR < 1.8 compared to INR >1.8,		0.47		0.02
lactate < 1.8 mmol/L compared to lactate >1.8 mmol/L		0.43		< 0.05
Neutrophil counts < 80% compared to counts >80%		0.43		< 0.05
Multivariate Cox Regression of Non Blood Parameters
Non Blood Parameters		HR		P value
Alcohol intake < 200g/day compared to >300g/day.		0.28		< 0.05
AARC score ≤ 7 compared to >10		0.10		0.03
SIRS (present v absent)		9.5		< 0.05
ROC Curve
Variables		Area
Daily amt of alcohol in gm		.580
Creatinine (mg/dl)		.637
AARC Score		.702
No of Organ failure		.656
Lactate		.687
Neutrophils (%)		.674

Disclosures:

Vivek Saini indicated no relevant financial relationships.

Sunil Kumar Dadhich indicated no relevant financial relationships.

Narendra Bhargava indicated no relevant financial relationships.

Sabir Hussain indicated no relevant financial relationships.

Sewaram Chaudhary indicated no relevant financial relationships.

Vivek Saini, MD, Sunil Kumar Dadhich, MD, PhD, FACG, Narendra Bhargava, MD, Sabir Hussain, MD, Sewaram Chaudhary, MD. P2348 - Simplified Prognostic Model for Predicting First 15 Days Mortality in Alcoholic Acute on Chronic Liver Failure Patients, ACG 2023 Annual Scientific Meeting Abstracts. Vancouver, BC, Canada: American College of Gastroenterology.