P3750 - ACLF Grade Evolution as a Predictor of Short-Term Outcomes in a Liver ICU

Alaina Miller, BS¹, Kelly Bowen, BS¹, Wesam Aleyadeh, MD², Leah G. Psellas, PA-C¹, Cheryl A. Milani, PA-C¹, Omar Sims, PhD³, Aanchal Kapoor, MD, MEd¹, Christina C. Lindenmeyer, MD⁴
1Cleveland Clinic Foundation, Cleveland, OH; 2Cleveland Clinic Akron General, Akron, OH; 3Cleveland Clinic Foundation, Hoover, AL; 4Cleveland Clinic, Cleveland, OH

Introduction: Patients with acute-on-chronic liver failure (ACLF) in the Intensive Care Unit (ICU) experience high rates of short-term mortality and require increased healthcare resource utilization. Understanding that ACLF is a dynamic syndrome, serial assessment of ACLF grades in critically ill patients is necessary to inform prognostication and liver transplant candidacy decision-making.

Methods: Patients admitted to a quaternary care center Liver ICU between August 2018 and August 2023 were enrolled into a prospective patient registry; 491 patients (614 ICU admissions) had ACLF defined by EASL-CLIF criteria. ACLF grade was assessed on ICU days (D) 1, 3 and 7; MELD-Na scores were assessed on D1 and 7. Patients were stratified by transplant-free survival (TFS) at 28 days. ACLF grade changes were classified as “resolved,” “improving”, "stable”, or “progressing.” Survival at 28 days was compared by grade trajectories using chi-square (survival status and ACLF trajectory) and Welch’s t-test (MELD-Na).

Results: ACLF-3 was present on D1 in a higher proportion of 28-day non-survivors than survivors (25.8% [50/194] vs 54.4% [174/320], p<0.001). Improvement in ACLF grade from D1 to D3 was significantly more likely to occur in survivors (35.6% vs. 10.3%, p<0.001). By D7, survivors were more likely to improve to ACLF grade 0 or 1 than non-survivors (46.9% vs 18.1%, p<0.001). Among those with ACLF-3 at D1, a higher proportion of survivors improved to grade 2 or 1 by D3 (47.5% vs 26.7%, p=0.008). MELD-Na was lower in survivors at D1 (29.24 vs. 32.73, p<0.001) and D7 (30.9 vs 35.55, p<0.001).

Discussion: Early improvement in ACLF grade within the first week of ICU admission is associated with improved 28-day TFS. Dynamic changes in ACLF grade and MELD-Na offer important prognostic value and may support liver transplant candidacy assessment in critically ill patients. Optimal management requires a multidisciplinary approach, with collaboration between hepatology, critical care, transplant, nephrology, and other specialist teams to implement timely organ-specific interventions and guide decision-making.

Disclosures:
Alaina Miller indicated no relevant financial relationships.
Kelly Bowen indicated no relevant financial relationships.
Wesam Aleyadeh indicated no relevant financial relationships.
Leah Psellas indicated no relevant financial relationships.
Cheryl Milani indicated no relevant financial relationships.
Omar Sims indicated no relevant financial relationships.
Aanchal Kapoor indicated no relevant financial relationships.
Christina Lindenmeyer indicated no relevant financial relationships.

Alaina Miller, BS¹, Kelly Bowen, BS¹, Wesam Aleyadeh, MD², Leah G. Psellas, PA-C¹, Cheryl A. Milani, PA-C¹, Omar Sims, PhD³, Aanchal Kapoor, MD, MEd¹, Christina C. Lindenmeyer, MD⁴. P3750 - ACLF Grade Evolution as a Predictor of Short-Term Outcomes in a Liver ICU, ACG 2025 Annual Scientific Meeting Abstracts. Phoenix, AZ: American College of Gastroenterology.