Supplementary Material for: Comparison of Mortality Prediction Scores in Intermediate-Care Patients with Liver Cirrhosis at a German university transplant Center; a prospective study

Background & Aims: Mortality prediction models help to extract and relate patient data upon admission to intensive or intermediate care units (ImCU). Considering technical and economic healthcare developments, re-evaluations of score performances are required to warrant their validity. This study validates and compares established scoring systems in cirrhotic ImCU-patients.
Methods: APACHE II, SAPS 2 and 3, SOFA, MPMo II and III, MELD, CLIF-C ACLF, CLIF-C AD and ImCUSS were calculated in patients with cirrhosis (n=98) at ImCU-admission. Discrimination performances were evaluated by area-under-the-receiver-operating-characteristic-curves (AUROCs), calibration performances with calibration belt plots and their corresponding p-values.
Results:Overall, SAPS 3 and CLIF-C ACLF have shown the best 90-day-mortality prediction outcomes with AUROCs of 0.825 and 0.783 along with calibration belt p-values of 0.128 and 0.061, respectively. In a subgroup analysis of patients with acute-on-chronic liver failure (ACLF), expanded SAPS 2, SOFA and SAPS 3 reached the best AUROCs, i.e., 0.760, 0.750 and 0.714, but none of the tested scores reached an acceptable calibration.
Conclusion: 90-day-mortality risk prediction of the SAPS 3 and CLIF-C ACLF was accurrate in our cohort of patients with liver cirrhosis admitted to ImCU. A particular challenge remains the mortality prediction in patients with ACLF requiring ImCU-level care; here, further developments are needed to generate scores with acceptable predictive performances.