Fig. 1.

Joint model use of value and slope (rate of change).

For 3 hypothetical patients A, B and C, the 20-day MELD-Na development is shown. After 20 days, patient A has a MELD-Na score of 30 and is thus prioritized by the current allocation system. However, the ACLF-JM uses both the estimated value (measured MELD-Na score) and slope (rate of change) at time=20 for survival prediction. Calculation of the HRs shows that the ACLF-JM gives patient C the greatest risk of death, because of the fast increase in MELD-Na scores (positive slope). See supplement 4 for the precise explanation and calculation. ACLF, acute-on-chronic liver failure; ACLF-JM, acute-on-chronic liver failure joint model; HR, hazard ratio; MELD-Na, model for end-stage liver disease-sodium.