A Novel Prognostic Score for 1-Year Adverse Outcomes in Non-ACLF Cirrhotic Patients After Discharge: A Multicenter Prospective Cohort Study

Abstract

Objectives: Discharged cirrhotic patients hospitalized for acute decompensation (AD) without acute-on-chronic liver failure (ACLF) have heterogeneous long-term prognosis; however, reliable prognostic tools are lacking. We aimed to identify the risk factors associated with 1-year adverse outcomes including mortality and liver transplantation (LT) after patient’s discharge and to develop an evidence-based prognostic model.

Methods: We enrolled 1212 and 621 cirrhotic patients who clinically improved after AD without ACLF before discharge from the Chinese AcuTe-on-CHronic LIver FailurE (CATCH-LIFE) derivation and validation cohorts, respectively. The primary outcome was 1-year adverse outcomes (all-cause mortality or LT) post-discharge. Independent risk factors for 1-year post-discharge adverse outcomes were identified using multivariable analysis, and a prognostic model was derived and validated.

Results: In the derivation cohort, 203 (16.7%) patients experienced 1-year adverse outcomes and 370 (30.5%) were readmitted within 90 days post-discharge. Age, prior decompensation, total bilirubin, international normalized ratio, albumin, and hemoglobin on discharge were independently associated with 1-year post-discharge adverse outcomes. The prognostic model achieved an area under the receiver operating characteristic curve (AUC) of 0.7767 (95% confidence interval [CI] 0.7408–0.8125) and 0.7274 (95% CI 0.6656–0.7892) in the derivation and validation cohorts. Using a risk threshold of ≥ 0.27, 17.70% of discharged non-ACLF cirrhotic patients with AD in the validation cohort were classified as high-risk, with 1-year adverse outcome rate being 43.96%.

Conclusion: A prognostic model for predicting 1-year adverse outcomes in discharged non-ACLF cirrhotic patients was developed and validated, with a high-risk cut-off ≥ 0.27, which may effectively stratify adverse outcome risks at 1-year post-discharge and guide intensive post-discharge management.

Keywords

acute-on-chronic liver failure / liver cirrhosis / patient discharge management / prognosis

RIGHTS & PERMISSIONS

2026 Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine and John Wiley & Sons Australia, Ltd.