Predictive scores for mortality in mafld-related acute-on-chronic liver failure (mafld-aclf): development and validation of mafld-meld-na and mafld-aarc scores

Background and Aim: The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and its related condition, MAFLD-related acute-on-chronic liver failure (MAFLD-ACLF), is increasing. However, the factors that determine the outcome in these patients have not been thoroughly studied. Methods: We examined a prospective cohort of patients with ACLF from the Asian Pacific Association for the Study of the Liver (APASL) ACLF Research Consortium (AARC) database to identify MAFLD as the cause of chronic liver disease. After excluding other known causes, we divided the cohort into two groups: a derivative cohort (n=258) to identify outcome-determining factors and create a predictive model, and a validation cohort (n=111) to validate the model. The outcome measured was death within 90 days, excluding transplanted patients. We analysed baseline clinical and laboratory features and severity scores. Results: The derivative cohort comprised 258 patients with a mean age of 53, of which 60% were males. Diabetes was present in 27% of the cohort, and hypertension in 29%. The dominant precipitating causes for ACLF included acute viral hepatitis (32%) and drug-induced liver injury (29%). The MELD-Na and AARC scores at admission were 32±6 and 10.4±1.9, respectively. At the 90-day follow-up, only 132 (51%) patients survived. Non-viral etiology, diabetes, bilirubin, INR, and encephalopathy were identified as independent factors influencing mortality. We developed the MAFLD-MELD-Na score (+12 points for diabetes and -12 points for viral etiology) and the MAFLD-AARC score (+5 for diabetes, -5 for viral etiology), which outperformed the general MELD-Na and AARC scores in predicting mortality in both the derivative and validation cohorts. Conclusion: Nearly half of the patients with MAFLD-ACLF die within 90 days. The presence of diabetes and non-viral precipitating causes independently affect the outcome. The newly developed and validated MAFLD-MELD-Na and MAFLD-AARC scores, calculated at baseline, effectively predict 90-day mortality in patients with MAFLD-ACLF.