Background: Acute on chronic liver failure (ACLF) is a condition precipitated by acute insult in a background of cirrhosis, which has a distinct clinical prognosis. qSOFA (Sequential Organ Failure Assessment), being simple bedside scoring system has been used in sepsis patients to predict the mortality. This study aimed at comparing qSOFA with existing ACLF prognostic scores in predicting the short term mortality.

Methods: In this prospective study, patients admitted to a tertiary care hospital with diagnosis of ACLF according to APASL definition were enrolled. We compared qSOFA scoring system with other scoring system : Chronic Liver Failure Consortium Organ Failure (CLIF-C-OF), Asia Pacific Association for the Study of the Liver-ACLF Research Consortium (AARC), Child-Turcotte-Pugh score ( CTP) and Model for End stage Liver Disease-sodium (MELD-Na) in predicting short term (28 and 90day) mortality. Prognostic score performance was evaluated using receiver operating characteristic (ROC) curves.

Results: Total of 112 (99 male-88.3%) patients with mean age of 46.3years were included in the study. On D1, AARC had the highest sensitivity predicting 90day mortality (0.785) compared to CLIF-C-OF (0.749), MELD-Na (0.776), CTP (0.689) and qSOFA (0.549). Among D7 scores, MELD-Na score had the highest sensitivity (0.841), compared to CLIF-C-OF (0.835), AARC (0.834), CTP (0.808) and qSOFA (0.784).

Conclusion: MELD-Na is better predictor of 90 day mortality among available scores.qSOFAis not better than existing ACLF scores in predicting mortality. However,qSOFA can be used to identify high risk ACLF patients at triage to decide on ICU management. Further study is needed to assess usefulness of qSOFA in ACLF patients with systemic inflammatory response syndrome (SIRS/sepsis).