ToolsCalculators
CLIF-C ACLF (Acute-on-Chronic Liver Failure) Score
Mortality prediction in acute-on-chronic liver failure from organ-failure grading, age, and WBC.
CLIF-C ACLF (Acute-on-Chronic Liver Failure) Score
Liver (bilirubin)
Kidney (creatinine / renal replacement)
Brain (hepatic encephalopathy grade)
Coagulation (INR)
Circulation
Respiration (PaO2/FiO2 or SpO2/FiO2)
Age
years
White blood cell count
x10^9/L
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When to use
- Estimating short-term (28/90-day) mortality in cirrhotic patients with acute-on-chronic liver failure, e.g. to inform ICU triage and transplant urgency discussions.
Formula
CLIF-C OF = sum of 6 organ-system sub-scores (liver, kidney, brain, coagulation, circulation, respiration; 1-3 each, range 6-18). CLIF-C ACLF = 10 x [0.33 x CLIF-C OF + 0.04 x age + 0.63 x ln(WBC, x10^9/L) - 2].
Pearls and pitfalls
- Outperformed MELD and MELD-Na for predicting 28-day mortality in the derivation cohort.
- Some ICU studies have used scores >=70 (assessed at day 3-7) as a marker of futility of continued intensive care; this alone should never be the sole basis for withdrawing care.