Predictive Scores for Mortality in MAFLD-related ACLF: Development and Validation of MAFLD-MELD-Na and MAFLD-AARC Scores

The increasing prevalence of NAFLD/MAFLD (metabolic-associated fatty liver disease)/MASLD has led to an increasing number of ACLF cases in the affected population. Although there is adequate data available on ACLF in general, along with data on ACLF in ALD, and HBV patients, studies on ACLF in MAFLD are sparse. This study was designed to answer some important clinical questions pertaining to MAFLD-ACLF outcomes, and improvements in the assessment of mortality risk among MAFLD-ACLF patients. The important findings and conclusion drawn from this study are:

• 50% of MAFLD-ACLF die by 90 days.
• Apart from the usual predictors (bil, INR, creat, etc.), two important predictors of mortality in MAFLD-ACLF are: Patients with diabetes mellitus (DM) have higher mortality than patients without DM. Non-viral precipitant - (e.g., DILI, Sepsis) have higher mortality than viral precipitants (HAV, HEV).
• The tweaked new score can be formulated using the formula: Usual score (MELD‑Na) + Diabetes + Etiology (nonviral).
• These scores are simple to calculate and are better at predicting the outcome as compared to their original versions. MELD-Na: Add 12 points for DM and 12 points for nonviral etiology. AARC: Add 5 points for DM and 5 points for nonviral etiology. However, these new scores will need further validation from prospective studies.