# Dynamic Changes in Bilirubin Predict 90-Day Mortality in Patients With Hepatocellular Carcinoma and Acute Decompensations of Cirrhosis: The HCC-AD Score

## TL;DR

A new score called HCC-AD predicts 90-day mortality in liver cancer patients based on bilirubin changes, outperforming existing tools.

## Contribution

A novel score using bilirubin dynamics to predict mortality in hepatocellular carcinoma patients during acute decompensation.

## Key findings

- The HCC-AD score stratifies patients into three risk groups with 26%, 49%, and 89% mortality rates.
- Bilirubin levels at admission and after 7 days were significant predictors of 90-day mortality.
- The HCC-AD score outperformed MELD 3.0 and Child-Pugh scores in predicting mortality for advanced HCC.

## Abstract

To develop a score to predict 90-day mortality in patients with hepatocellular carcinoma (HCC) admitted with an acute decompensation (AD) event of chronic liver disease.

This retrospective cohort study was conducted at Blacktown and Westmead Hospitals in Australia, including patients with decompensated cirrhosis and concomitant HCC between January 1, 2012, and May 31, 2023. Participants were separated into derivation (n=233) and validation (n=132) cohorts. Demographic and clinical data were collected at admission and day 7. Independent predictors for 90-day transplant-free survival were entered into classification and regression tree analysis to develop the HCC-AD score. Discrimination was assessed in the validation cohort using Harrell C statistic. Subgroup analysis was conducted for each Barcelona Clinic Liver Cancer (BCLC) class with comparisons made to current scores.

A cohort of 355 patients was considered. Admission bilirubin (P=.009) and 7-day change in bilirubin (P=.018) remained significant for 90-day mortality in multivariable analysis. The HCC-acute decompensation (AD) score stratified patients into 3 risk groups with predicted mortality of 26%, 49%, and 89%, respectively. The HCC-AD score showed good discrimination (Harrell C=0.731). Cox regression analysis determined the HCC-AD score remained predictive in BCLC B (P<.001), C (P<.001), and D (P=.010) scored HCC. The model for end-stage liver disease 3.0 (P=.058) and Child-Pugh (P=.11) scores were not predictive in BCLC D HCC.

A simple score that stratifies patients with HCC into 3 risk categories based on changes in bilirubin predicts 90-day mortality following an acute decompensatory event. It is superior to other scores in advanced HCC.