CLIF-C OF score

The CLIF-C organ failure (OF) score is used to diagnose acute-on-chronic liver failure (ACLF) in patients with acute decompensation of cirrhosis. It also helps assess the severity of ACLF through the evaluation of six major organ systems.

Calculation

Each organ system is scored on a scale to generate the overall CLIF-C OF score, ranging from 0 to 18. A higher CLIF-C OF score translates into a higher ACLF grade.

CLIF-C ACLF score

The CLIF-C acute-on-chronic liver failure (ACLF) score is used to predict prognosis of patients with ACLF.

Calculation

The CLIF-C ACLF score combines the CLIF-C OF score with the patient’s age and white blood cell count to generate a composite score, ranging from 0 to 100.

CLIF-C ACLF score = 10 × (0.33 × CLIF-C OF score + 0.04 × age [years] + 0.63 × ln (white blood cell count [× 10⁹ cells/L]) – 2)

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 articles

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

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

Validation

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 2018, 22 (1), 254. DOI: 10.1186/s13054-018-2156-0