CLIF-C AD score

The CLIF-C acute decompensation (AD) score is used to predict prognosis of patients with acute decompensation of cirrhosis who do not have acute-on-chronic liver failure (ACLF).

Calculation

The CLIF-C AD score integrates a series of clinical and laboratory parameters that reflect the severity of underlying liver disease and the patient’s overall health status.

CLIF-C AD score = 10 × (0.03 × age [years] + 0.66 × ln (creatinine [mg/dL]) + 1.71 × ln (INR) + 0.88 × ln (white blood cell count [× 10⁹ cells/L]) – 0.05 × (sodium [mmol/L]) + 8)

The EASL Clinical Practice Guidelines on acute-on-chronic liver failure recommend the sequential use of the CLIF-C predictive scores in patients with cirrhosis admitted to hospital with acute decompensation of cirrhosis.

Clinical application

• Risk stratification: Allows clinicians to categorize patients based on the severity of organ failure, facilitating tailored clinical management strategies.
• Treatment decisions: Assists in determining the urgency and guides the type of interventions required, including the need for intensive care or liver transplantation.
• Resource allocation: Helps prioritize patients for limited healthcare resources, ensuring that those with the highest need receive appropriate care.
• Monitoring disease progression: Provides a framework for tracking changes in organ function over time, aiding in the assessment of treatment efficacy and disease progression.
• Patient counseling: Provides a quantitative basis for discussing prognosis and potential outcomes with patients and their families, supporting shared decision-making.

Limitations

While the CLIF-C scores are robust and reliable prognostic tools, they have some limitations:

• They are specifically designed for patients with acute decompensation of cirrhosis and are not applicable to other patient populations.
• They should be used in conjunction with clinical judgment and other diagnostic information, as individual patient circumstances can vary.

Original article

Jalan, R., Pavesi, M., Saliba, F., Amorós, A., Fernandez, J., Holland-Fischer, P., Sawhney, R., Mookerjee, R., Caraceni, P., Moreau, R., Ginès, P., Durand, F., Angeli, P., Alessandria, C., Laleman, W., Trebicka, J., Samuel, D., Zeuzem, S., Gustot, T., Gerbes, A. L., Wendon, J., Bernardi, M., Arroyo, V., CANONIC study investigators of the EASL-CLIF Consortium. The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure. J. Hepatol. 2015, 62 (4), 831–840. DOI: 10.1016/j.jhep.2014.11.012