394: OUTCOMES OF ACUTE LIVER FAILURE PATIENTS NOT LISTED FOR LIVER TRANSPLANTATION: A COHORT ANALYSIS
Bibliographic record
Abstract
Introduction: Acute liver failure (ALF) is a rare condition leading to intensive care unit admission and significant morbidity and mortality. Liver transplantation (LT) is often required as a life saving measure. However patients are not always listed for LT and there is lack of data around the outcomes of such patients. Our aim is to describe outcomes of ALF patients not listed for LT and identify factors associated with death at 21 days. Methods: Retrospective analysis of all ALF patients not listed for LT enrolled in the US Acute Liver Failure Study Group (US-ALFSG) registry between 1998 and 2018. Primary outcome was death at 21 days. Patients deceased at 21 days were compared to those alive at 21 days. Multivariable logistic regression was done to identify factors associated with death at 21 days. Results: 1672 ALF patients were not listed for LT. Median age was 41 [Interquartile Range (IQR) 30-54] and 527 (31.5%) were male. 371 (28.9%) patients were too sick to list. Most common etiology was acetaminophen toxicity (54.8%). 330 (19.7%) patients met King’s College Criteria (KCC) for LT. Median ALFSG Prognostic Index (ALFSG-PI) was 38% (IQR 13.2%-71.5%) chance of spontaneous survival. 951 (56.9%) patients required mechanical ventilation, 564 (33.7%) needed vasopressors, and 246 (14.7%) required continuous renal replacement therapy (CRRT). 558 (35.7%) patients died at 21 days. Compared to those who survived, patients who died were more likely to be too sick for listing (56.8% vs 15.5%), have a non-acetaminophen etiology (62.7% vs 36.9%), fulfil KCC (41.4% vs 9.2%), have lower ALFSG-PI (11.4% vs 53.9%), need mechanical ventilation (78.9% vs 46.2%), need vasopressors (61.6% vs 19.5%), and need CRRT (20.3% vs 13%) (p< 0.05 for all). After adjusting for relevant covariates, age [adjusted odds ratio (aOR) 1.03, 95% confidence interval (CI) 1.02-1.04], KCC (aOR 3.17, CI 2.23-4.51), grade 3/4 encephalopathy (aOR 1.83, CI 1.18-2.83), mechanical ventilation (aOR 1.53, CI 1.01-2.33), and vasopressors (aOR 2.10, CI 1.43-3.08) (p< 0.05 for all) were all independently associated with death at 21 days. Conclusions: Despite no LT, majority of patients were still alive at 21 days. Multiorgan failure resulting in grade 3/4 encephalopathy, need for mechanical ventilation, and need for vasopressors lead to poor prognosis.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.002 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".