by First Hospital of Jilin University

ACLF, acute-on-chronic liver failure; APASL, Asian-Pacific Association for the Study of the Liver; INR, international normalized ratio; MELD, model for end-stage liver disease; TBiL, total bilirubin; WBC, white blood cell count. Credit: Xia Yu, Ruoqi Zhou, Wenting Tan, et al.

Researchers have unveiled an advancement in liver failure care: the CATCH-LIFE-MELD score (Chinese Acute-on-Chronic Liver Failure Consortium (CATCH-LIFE)-MELD score). This innovative tool, developed by an international team led by Xia Yu and colleagues, enhances the accuracy of predicting short-term survival outcomes for patients suffering from acute-on-chronic liver failure (ACLF).

The study, published in eGastroenterology, promises to improve patient management and treatment planning for this life-threatening condition.

“ACLF presents unique challenges due to its rapid progression and high mortality rates,” said Dr. Yu Shi, senior researcher at Zhejiang University and one of the study’s lead authors. “Our goal was to create a model that addresses the limitations of existing prognostic tools, providing clinicians with a more reliable method to assess risk and tailor interventions.”

What is the CATCH-LIFE-MELD score?

The Model for End-Stage Liver Disease (MELD) score has long been used to prioritize organ transplants and assess liver disease severity. However, its effectiveness in predicting ACLF outcomes is limited. The CATCH-LIFE-MELD score improves on this by incorporating three additional parameters—patient age, neutrophil count (an indicator of inflammation), and hepatic encephalopathy grade (a measure of brain dysfunction).

This refined tool was tested in over 750 patients across two large cohorts, demonstrating superior predictive accuracy for 28- and 90-day mortality compared to traditional models. It also remained robust across subgroups, including patients with hepatitis B, cirrhosis, and varying degrees of organ failure.

“Our findings show that the CATCH-LIFE-MELD score has the potential to not only predict survival more accurately but also assist clinicians in identifying high-risk patients who may benefit most from urgent interventions, such as liver transplantation,” explained Dr. Jifang Sheng, another senior co-author.

• (A) Derivation cohort. (B) Validation cohort. The cumulative incidence of death at 28/90 days was stratified according to the CATCH-LIFE-MELDs classification rule (low risk/intermediate risk/high risk: CATCH-LIFE-MELDs <3.09/3.09–5.04/>5.04). P<0.001 (log-rank test) for comparisons of survival probability among the three risk strata. Credit: Xia Yu, Ruoqi Zhou, Wenting Tan, et al.
• ACLF, acute-on-chronic liver failure; CATCH-LIFE-MELDs, Chinese Acute-on-Chronic Liver Failure Consortium-MELD score; CLIF-C ACLFs, Chronic Liver Failure Consortium ACLF score; COSSH ACLFs, Chinese Group on the Study of Severe Hepatitis B ACLF score; COSSH-ACLF IIs, COSSH-ACLF II score; MELDs, model for end-stage liver disease score; MELD-Nas, MELD with sodium score. Credit: Xia Yu, Ruoqi Zhou, Wenting Tan, et al.
• (A) Derivation cohort. (B) Validation cohort. The cumulative incidence of death at 28/90 days was stratified according to the CATCH-LIFE-MELDs classification rule (low risk/intermediate risk/high risk: CATCH-LIFE-MELDs <3.09/3.09–5.04/>5.04). P<0.001 (log-rank test) for comparisons of survival probability among the three risk strata. Credit: Xia Yu, Ruoqi Zhou, Wenting Tan, et al.
• ACLF, acute-on-chronic liver failure; CATCH-LIFE-MELDs, Chinese Acute-on-Chronic Liver Failure Consortium-MELD score; CLIF-C ACLFs, Chronic Liver Failure Consortium ACLF score; COSSH ACLFs, Chinese Group on the Study of Severe Hepatitis B ACLF score; COSSH-ACLF IIs, COSSH-ACLF II score; MELDs, model for end-stage liver disease score; MELD-Nas, MELD with sodium score. Credit: Xia Yu, Ruoqi Zhou, Wenting Tan, et al.

Why it matters

ACLF is a severe complication of chronic liver disease, marked by rapid organ failure and a high risk of death. While liver transplantation is a potential lifesaver, the shortage of donor organs necessitates accurate risk stratification to prioritize care. The CATCH-LIFE-MELD score’s enhanced precision could improve patient outcomes and resource allocation.

The model also has implications for global health. “Since the parameters we used are commonly measured in clinical settings, the CATCH-LIFE-MELD score can be easily implemented worldwide, including in low-resource areas,” said Dr. Ruoqi Zhou, another lead researcher.

While this model has been validated in Asian populations, predominantly those with hepatitis B-related liver failure, further studies are planned to test its applicability to Western cohorts, where alcohol-related liver disease is more prevalent.

“Our work represents a critical step forward in personalized medicine for ACLF,” said Dr. Xia Yu. “We hope this model will guide new therapeutic approaches and ultimately save lives.”

More information: Xia Yu et al, Evidence-based incorporation of key parameters into MELD score for acute-on-chronic liver failure, eGastroenterology (2024). DOI: 10.1136/egastro-2024-100101

Provided by First Hospital of Jilin University

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