Machine Learning for Mortality Prediction in Cirrhotic Sepsis: Moving Beyond MELD, SOFA, and CLIF-SOFA
Researchers developed machine learning models to predict in-hospital mortality for patients with cirrhosis and sepsis. By integrating diverse clinical variables, these algorithms outperformed traditional scoring systems like MELD and SOFA.
Sepsis in patients with cirrhosis carries an in-hospital mortality exceeding 40%, reflecting a pathophysiology distinct from sepsis in non-cirrhotic hosts. Cirrhosis- associated immune dysfunction, gut bacterial translocation, splanchnic vasodilatation, and impaired hepatic clearance together amplify septic organ failure. 1,2 Despite this, prognostication continues to rely on scores developed for unrelated purposes: Model for End-Stage Liver Disease (MELD) and MELD-Na for transplant allocation, 3,4 Sequential Organ Failure Assessment (SOFA) for general critical illness, 5 and Chronic Liver Failure-SOFA (CLIF-SOFA) for acute-on-chronic liver failure. 6 Each captures only part of the relevant biology. The authors therefore developed machine learning (ML) models that simultaneously integrate hepatic, renal, haemodynamic, and inflammatory variables, and benchmarked them against established scores. 7
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