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.研究背景与目的：死亡预测模型可对收治于重症与中级监护病房（ImCU）的患者入院数据进行提取与关联分析。鉴于医疗领域技术与经济层面的发展，需对各类评分系统的预测表现进行重新评估，以确保其有效性。本研究针对收治于ImCU的肝硬化患者，对已确立的临床评分系统开展验证与对比分析。 研究方法：本研究纳入98例肝硬化患者，在其收治至ImCU时，计算急性生理学与慢性健康状况评分系统II（APACHE II）、简化急性生理学评分2/3（SAPS 2/SAPS 3）、序贯器官衰竭评分（SOFA）、死亡概率模型II/III（MPMo II/III）、终末期肝病模型（MELD）、慢性肝衰竭-急性加重评分（CLIF-C ACLF）、慢性肝衰竭-急性失代偿评分（CLIF-C AD）以及重症与中级监护病房评分（ImCUSS）。采用受试者工作特征曲线下面积（AUROCs）评估各评分系统的鉴别性能，采用校准带图及其对应p值评估校准性能。 研究结果：整体而言，SAPS 3与CLIF-C ACLF在90天死亡预测中表现最优，其AUROC分别为0.825与0.783，校准带p值分别为0.128与0.061。在慢加急性肝衰竭（ACLF）患者的亚组分析中，扩展版SAPS 2、SOFA与SAPS 3取得了最优AUROC，分别为0.760、0.750与0.714，但所有受试评分系统均未达到可接受的校准效果。 研究结论：本研究队列中，SAPS 3与CLIF-C ACLF对收治于ImCU的肝硬化患者的90天死亡风险预测较为准确。对于需要ImCU级照护的ACLF患者，其死亡预测仍是一项重大挑战，未来需进一步研发具备可接受预测性能的临床评分系统。