CLIF-SOFA score

The CLIF-SOFA score adapts the SOFA score to cirrhosis. Each of six organ systems scores 0 to 4, giving a total out of 24, and defines organ failure for the EASL-CLIF grade of acute-on-chronic liver failure (ACLF). The simpler CLIF-C OF score is derived from it.

Blood resultsTotal bilirubin µmol/LCreatinine µmol/LOn renal replacement therapyINR Platelets × 10⁹/L

Hepatic encephalopathy (West Haven grade)NoneGrade 1Grade 2Grade 3Grade 4

CirculationMean arterial pressure 70 mmHg or moreMean arterial pressure below 70 mmHgDopamine 5 µg/kg/min or less, dobutamine, or terlipressinDopamine above 5, or adrenaline or noradrenaline 0.1 µg/kg/min or lessDopamine above 15, or adrenaline or noradrenaline above 0.1 µg/kg/min

Respiration

PaO₂ in mmHg and FiO₂ as a fraction. Use SpO₂/FiO₂ when there is no arterial gas.

PaO₂/FiO₂ above 400, or SpO₂/FiO₂ above 512PaO₂/FiO₂ 301 to 400, or SpO₂/FiO₂ 358 to 512PaO₂/FiO₂ 201 to 300, or SpO₂/FiO₂ 215 to 357PaO₂/FiO₂ 101 to 200, or SpO₂/FiO₂ 90 to 214, or mechanical ventilationPaO₂/FiO₂ 100 or less, or SpO₂/FiO₂ 89 or less

Enter the values above.

Organ failure

Organ	Failure defined as
Liver	Bilirubin 205 µmol/L (12 mg/dL) or more
Kidney	Creatinine 177 µmol/L (2 mg/dL) or more, or renal replacement therapy
Brain	West Haven grade 3 or 4
Coagulation	INR 2.5 or more, or platelets 20 or less
Circulation	Vasopressors or terlipressin
Respiration	PaO₂/FiO₂ 200 or less, SpO₂/FiO₂ 214 or less, or mechanical ventilation

ACLF grade

No ACLF: no organ failure; a single non-kidney organ failure with creatinine below 133 µmol/L and no encephalopathy; or single brain failure with creatinine below 133 µmol/L.
Grade 1: single kidney failure; a single liver, coagulation, circulation or respiratory failure with creatinine 133 to 176 µmol/L and/or grade 1 or 2 encephalopathy; or single brain failure with creatinine 133 to 176 µmol/L.
Grade 2: two organ failures. Grade 3: three or more.

Reference

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.