Value of four scoring systems in evaluating the prognosis of cirrhotic patients with infection

Objective To investigate the value of Child-Turcotte-Pugh (CTP) score, Model for End-Stage Liver Disease (MELD) score, chronic liver failure-sequential organ failure assessment (CLIF-SOFA) score, and APASL-ACLF Research Consortium (AARC) score in evaluating the prognosis of cirrhotic patients with infection.Methods A retrospective analysis was performed for the clinical data of cirrhotic patients with infection who were admitted to The First Hospital Affiliated to Soochow University from January 2014 to December2017, and according to their prognosis during hospitalization, they were divided into group A (patients with a stable disease after comprehensive internal medicine treatment) and group B (patients who died during hospitalization, who left the hospital and gave up treatment, or who underwent liver transplantation due to no response to internal medicine treatment) .The two groups were compared in terms of general information, the worst values of clinic indices during hospitalization, CTP score, MELD score, CLIF-SOFA score, AARC score, and organ replacement therapy (including mechanical ventilation, artificial liver support system, and renal replacement therapy) .The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups.A logistic regression analysis was performed for the variables with statistical significance in the univariate analysis, and the receiver operating characteristic (ROC) curve was used to assess the efficiency of these four scoring systems in predicting prognosis.Results A total of 522 cirrhotic patients with infection were enrolled, among whom 381 survived and 141 died, resulting in a mortality rate of 27.01%.The univariate analysis showed that there were significant differences between the two groups in platelet count, total bilirubin, arterial blood lactate, international normalized ratio, CTP score, MELD score, CLIF-SOFA score, and AARC score (all P<0.05) , and the multivariate logistic regression analysis showed that all these four scoring systems had a strong predictive value and CTP score (odds ratio[OR]=2.308, 95%confidence interval[CI]:0.640-0.796, P=0.016) , MELD score (OR=0.632, 95%CI:0.638-0.814, P=0.007) , CLIF-SOFA score (OR=1.920, 95%CI:0.788-0.908, P=0.017) , and AARC score (OR=0.713, 95%CI:0.751-0.882, P=0.005) were independent factors for the prognosis of cirrhotic patients with infection.The ROC curve analysis showed that all these four scoring systems could predict the prognosis of cirrhotic patients with infection, and the CLIF-SOFA score had the strongest predictive efficiency, with a sensitivity of 0.854, a specificity of 0.690, and an area under the ROC curve of 0.848.Conclusion CTP score, MELD score, CLIF-SOFA score, and AARC score can predict the prognosis of cirrhotic patients with infection and provide guidance to anti-infective therapy.Among them, CLIF-SOFA score has a high predictive value and can be widely used in clinical practice.