Perioperative medicine & outcomes
Cardiac Biomarkers and Risk Stratification in Liver Transplantation for Acute-on-chronic Liver Failure: Refining Current Risk Models for Improved Prediction of Posttransplant Mortality
Authors' conclusion
Cardiac impairment is prevalent in patients with ACLF and crucial for risk stratification. Integrating cardiac biomarkers into ACLF risk models improves survival predictions after liver transplant
Study context
- Population
- Consecutive patients with acute-on-chronic liver failure (ACLF) undergoing liver transplant, ASAN-Liver Transplant Registry, 2008–2019
- Participants
- 710 patients
- Exposure
- Sundaram ACLF-Liver Transplant-Mortality (SALT-M)_ CARDIAC score vs original SALT-M score
- Outcome
- Mortality after liver transplant (optimism-corrected C-index)
- Follow-up
- 30 days
Methodological detailsregistry-based, risk model development
- Registry-based
- Risk model development
Main finding
As reported in the abstract
Optimism-corrected C-index for 30-day mortality
SALT-M_ CARDIAC
0.76
SALT-M
0.73
P < 0.001
Observational data: associations, not effects.
Further findings
BNP >400 pg/ml (suggestive of acute HF)
hsTnI >10-fold upper limit
C-index for 30-day mortality with cardiac biomarkers added
- NACSELD-ACLF: from 0.68 to 0.75
- Chronic Liver Failure Consortium-Organ Failure: from 0.72 to 0.75
Feature importance (Shapley Additive exPlanations)
- BNP and high-sensitivity troponin I (hsTnI) important predictors of mortality after liver transplant
Original publication
Cardiac Biomarkers and Risk Stratification in Liver Transplantation for Acute-on-chronic Liver Failure: Refining Current Risk Models for Improved Prediction of Posttransplant Mortality. Anesthesiology. Published 10 September 2025. doi:10.
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