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The Chronic Liver Failure Consortium acute-on-chronic liver failure (CLIF-C ACLF) score predicts mortality at 1, 3, 6 and 12 months in hospitalized cirrhotic patients with acute-on-chronic liver failure.

CLIF-C ACLF (Acute-on-Chronic Liver Failure) score:
CLIF-ACLFs =10*[0.33*CLIF-OFs + 0.04*Age + 0.63*Ln(white-cell count) – 2]

ACLF grade


a) No organ failure
b) One organ failure (liver, coagulation, circulatory, respiratory) with creatinine < 1.5 mg/dL and no HE
c) Single cerebral failure and creatinine< 1.5 mg/dL

ACLF grade 1
a) Single kidney failure
b) Single liver, coagulation circulatory or respiratory failure + creatinine 1.5-1.9 mg/dL and/or HE I-II
c) Single cerebral failure (HE III-IV) + creatinine 1.5-1.9 mg/dL

ACLF grade 2 2 organ failures
ACLF grade 3 3 or more organ failurescore

Original article

Jalan, R., Saliba, F., Pavesi, M., Amoros, A., Moreau, R., Ginès, P., Levesque, E., Durand, F., Angeli, P., Caraceni, P., Hopf, C., Alessandria, C., Rodriguez, E., Solis-Muñoz, P., Laleman, W., Trebicka, J., Zeuzem, S., Gustot, T., Mookerjee, R., Elkrief, L., Soriano, G., Cordoba, J., Morando, F., Gerbes, A., Agarwal, B., Samuel, D., Bernardi, M., Arroyo, V., CANONIC study investigators of the EASL-CLIF Consortium. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J. Hepatol. 2014, 61 (5), 1038–1047. DOI: 10.1016/j.jhep.2014.06.012


Engelmann, C., Thomsen, K. L., Zakeri, N., Sheikh, M., Agarwal, B., Jalan, R., & Mookerjee, R. P. Validation of CLIF-C ACLF score to define a threshold for futility of intensive care support for patients with acute-on-chronic liver failure. Crit. Care 201822 (1), 254. DOI: 10.1186/s13054-018-2156-0

CLIF-C OF score calculator

Liver score

Liver failure Yes No
Renal replacement therapy
Yes No
Kidney score

Kidney failure Yes No
West–Haven grade for hepatic encephalopathy (HE)
Brain score

Brain failure Yes No
International normalized ratio (INR)
Coagulation score

Coagulation failure Yes No
Mean arterial pressure (MAP)
Use of vasopressors (circulatory failure indication)
Yes No
Circulatory score

Circulatory failure Yes No
Select one: PaO2 (preferred) SpO2
mmHg %
Mechanical ventilation (respiratory failure indication)
Yes No
Respiratory failure (medical opinion)
Yes No
Respiratory score

Respiratory failure Yes No
Total no. of organ failures

CLIF-C OF score
ACLF grade