A HDL-based cirrhosis risk score improves the prediction of short-term mortality in acutely decompensated cirrhosis

作者：R Stauber, Eva M. Usón-Raposo, Florian Rainer, Georg Kramer, Vanessa Stadlbauer, Hubert Scharnagl, Lorenz Balcar, Vlad Țâru, Maria Laura Robone, M. Bonomo, Chiara Lisi, Cristina Sánchez-Garrido, Salvatore Piano, Paolo Caraceni, Wim Laleman, Mattias Mandorfer, Gunther Marsche, Joan Clãria, Jonel Trebicka, Thomas Reiberger, Carlo Alessandria, Paolo Angeli, Richard Moreau · 发表于：Liver Transplantation · 年份：2026 · DOI：10.1097/lvt.0000000000000915 · 研究领域：Liver Disease and Transplantation、Liver Disease Diagnosis and Treatment、Organ Transplantation Techniques and Outcomes

Liver failure is associated with severe lipid alterations, including pronounced reductions of high-density lipoprotein cholesterol (HDL-C) levels that are also of prognostic value. In the present study, we developed an optimized prognostic model based on HDL-C and other readily available blood parameters for survival prediction in patients with acutely decompensated (AD) cirrhosis. We measured HDL-C in biobanked plasma samples of patients recruited from the large prospective CANONIC and PREDICT cohorts. Multivariable competing risk analysis was performed with death as the event of interest and liver transplantation (LT) as the competing risk. Cox proportional hazards regression was used to construct a new prognostic model, and its performance was evaluated using the C-index and compared with other prognostic scores using the Integrated Discrimination Index statistics test. We analyzed 1035 patients with AD/ACLF (median age 59 y; 70% male; ACLF at inclusion 20%; etiology alcohol 59%). Multivariable analysis yielded 6 independent prognostic variables associated with 90-day survival: age, HDL-C, creatinine, sodium, WBC, and INR, which were incorporated in a new prognostic model termed CLIF-C HDL score. The new model showed superior discrimination ability for the prediction of 90-day mortality by C-index of 0.768 for CLIF-C HDL score versus 0.735 for MELD-Na ( p <0.001) versus 0.738 for MELD 3.0 ( p <0.001). This superior performance of the CLIF-C HDL score was confirmed in 2 ext...