CLIF-C scores
For a patient with cirrhosis admitted with acute decompensation. The CLIF-C organ failure (OF) score identifies organ failures and the grade of acute-on-chronic liver failure (ACLF). The prognostic score then follows: the CLIF-C ACLF score if ACLF is present, or the CLIF-C AD score if it is not.
Enter the values above.
CLIF-C organ failure score
| Organ | 1 point | 2 points | 3 points |
|---|---|---|---|
| Liver (bilirubin) | Below 102.6 µmol/L (6 mg/dL) | 102.6 to 205.1 µmol/L | 205.2 µmol/L (12 mg/dL) or more |
| Kidney (creatinine) | Below 176.8 µmol/L (2 mg/dL) | 176.8 to 309.3 µmol/L | 309.4 µmol/L (3.5 mg/dL) or more, or RRT |
| Brain (West Haven) | Grade 0 | Grade 1 or 2 | Grade 3 or 4 |
| Coagulation (INR) | Below 2.0 | 2.0 to 2.4 | 2.5 or more |
| Circulation | MAP 70 mmHg or more | MAP below 70 mmHg | Vasopressors |
| Respiration | PaO₂/FiO₂ above 300 or SpO₂/FiO₂ above 357 | 201 to 300, or 215 to 357 | 200 or less, or 214 or less |
Bold cells are organ failure. Kidney failure starts at a creatinine of 176.8 µmol/L (2 mg/dL).
ACLF grade
- No ACLF: no organ failure; or a single failure of the liver, coagulation, circulation or respiration with creatinine below 132.6 µmol/L (1.5 mg/dL) and no encephalopathy; or single brain failure with creatinine below 132.6 µmol/L.
- ACLF grade 1: single kidney failure; or a single failure of the liver, coagulation, circulation or respiration with creatinine 132.6 to 176.7 µmol/L (1.5 to 1.9 mg/dL) and/or grade 1 or 2 encephalopathy; or single brain failure with creatinine 132.6 to 176.7 µmol/L.
- ACLF grade 2: two organ failures.
- ACLF grade 3: three or more organ failures.
Prognostic scores
- CLIF-C ACLF = 10 × (0.33 × CLIF-C OF score + 0.04 × age + 0.63 × ln white cell count − 2). Range roughly 25 to 95; mortality rises steeply with the score.
- CLIF-C AD = 10 × (0.03 × age + 0.66 × ln creatinine in mg/dL + 1.71 × ln INR + 0.88 × ln white cell count − 0.05 × sodium + 8). 45 or less is low risk, 46 to 59 intermediate, and 60 or more high risk.
Notes
- Score at admission and again at 3 to 7 days. The grade on days 3 to 7 predicts outcome better than the grade at admission.
- With ACLF grade 3, four or more organ failures and a CLIF-C ACLF score above 70 after 3 to 7 days of full intensive care support, 28-day mortality approaches 100% without transplant. EASL suggests this can inform discussions about limiting care in patients who are not transplant candidates, but it should not be the sole basis for that decision.
- ACLF, particularly grade 2 or 3, should prompt early discussion with a liver transplant unit.
References
Jalan R, Saliba F, Pavesi M, et al. 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.
Jalan R, Pavesi M, Saliba F, et al. 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.
Moreau R, Jalan R, Gines P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013;144(7):1426-1437.
European Association for the Study of the Liver. EASL Clinical Practice Guidelines on acute-on-chronic liver failure. J Hepatol. 2023;79(2):461-491.