Copyright
©The Author(s) 2022.
World J Hepatol. Dec 27, 2022; 14(12): 2025-2043
Published online Dec 27, 2022. doi: 10.4254/wjh.v14.i12.2025
Published online Dec 27, 2022. doi: 10.4254/wjh.v14.i12.2025
Table 1 Child-Turcotte-Pugh scores
| Points | 1 | 2 | 3 |
| Ascites | Absent | Slight | Moderate |
| Serum Bilirubin (mg/dL) | < 2 | 2-3 | > 3 |
| Serum Albumin (g/dL) | > 3.5 | 2.8-3.5 | < 2.8 |
| PT ratio or | < 4 | 4-6 | > 6 |
| INR | < 1.7 | 1.7–2.3 | > 2.3 |
| HE | None | Grade I-II | Grade III-IV |
| MELD | Mortality rate (%) | MELD-Na | Mortality rate (%) (90-d) |
| ≤ 9 | 1.9 | < 17 | < 2 |
| 10-19 | 6 | 17-20 | 3-4 |
| 20-29 | 19.6 | 21-22 | 7-10 |
| 30-39 | 52.6 | 23-26 | 14-15 |
| ≥ 40 | 71.3 | 27-31 | 27-32 |
| ≥ 32 | 65-66 | ||
Table 3 CLIF-SOFA score[64]
| Points | 0 | 1 | 2 |
| Liver Bilirubin (mg/dL) | < 1.2 | ≥ 1.2 - < 2.0 | ≥ 2.0 - < 6.0 |
| Renal Creatinine (mg/dL) | < 1.2 | ≥ 1.2 - < 2.0 | ≥ 2.0 - < 3.5 |
| Neurological HE grade | - | 1 | 2 |
| Haematological INR | < 1.1 | ≥ 1.1 - < 1.25 | ≥ 1.25 - < 1.5 |
| Circulation MAP (mmHg) | ≥ 70 | < 70 | Dopamine ≤ 5 or Dobutamine or Terlipressin |
| Respiratory PaO2 /FiO2 or SpO2 /FiO2 | > 400; > 512 | > 300-≤ 400; > 357 - ≤ 512 | > 200 - ≤ 300; > 214 - ≤ 357 |
Table 4 Summary of selected studies
| Ref. | Year | Country | Aim | Setting | Results | Conclusions |
| Kuo et al[65] | 2021 | Taiwan | Assess the predictive value and clinical reliability of three different scores | ACLF patients admitted to the ICU | Non-survivor: CLIF-C ACLF, CLIF-C ACLF lactate, and CLIF-C ACLF-D were 58.85 ± 11.40, 60.88 ± 13.71, and 34.03 ± 1.57, respectively. Survivor: 44.55 ± 9.14, 46.91 ± 11.66, and 32.29 ± 1.17, respectively, (all P values < 0.01) | The CLIF-C ACLF-D score may be a better predictor of short- and long-term mortality |
| Li et al[66] | 2017 | China | Assess various prognostic scores, such as the CLIF-C OFs, CLIF-SOFAs, CLIF-C ACLFs, ACLF grade, and MELD, predicted short-term (28-d) mortality | CHB patients with ACLF | Scores in no ACLF group and for ACLF group grades 1, 2, and 3, respectively: CLIF-C OFs: 7, 9, 10, and 13; CLIF-C ACLFs: 29, 37, 44, and 60; CLIF-SOFAs: 5, 7, 9, and 13; MELDs: 16, 22, 30, and 37 | CLIF-C OF score outperforms other scores |
| Dong et al[67] | 2020 | China | Determine the characteristics and outcomes of ACLF | ACLF patients who have or do not have cirrhosis | COSSH ACLF score (AUROC = 0.778 or 0.792, 95%CI 0.706-0.839 or 0.721–0.851) displayed the better prognostic ability for EASL ACLF patients with non-cirrhosis. CLIF-C ACLF score (AUROC = 0.757 or 0.796, 95%CI 0.701–0.807 or 0.743-0.843) still was the best prognostic scoring system in EASL ACLF patients with cirrhosis | CLIF-C ACLF score was better at predicting short-term mortality in ACLF patients with cirrhosis, while the COSSH ACLF score was better for ACLF patients without cirrhosis |
| Grochot et al[68] | 2020 | Brazil | Determine the accuracy of the presence of ACLF in predicting mortality. | Patients with cirrhosis | CLIF-SOFA score at 28-, 90-, and 365-d was 1.32, 1.3, and 1.2, respectively. CLIF-C AD/ACLF score was 1.0, 1.0, and 1.0, respectively | CLIF-SOFA score increased mortality by 1.3 times for each point |
| Jacques et al[41] | 2020 | Brazil | Assess and compare the liver-specific scores ability to predict mortality | Cirrhotic patients with SBP | CLIF-SOFA was able to predict mortality at 30-, 90-, and 365-d, with an AUROC of 0.75, 0.64, and 0.64, respectively. CLIF-C AD or CLIF ACLF scores 0.59, 0.51, and 0.52, respectively | CLIF-SOFA outperformed other liver-specific measures |
| Terres et al[39] | 2022 | Brazil | Assess and compare the significance of liver-specific scores in predicting mortality | HRS patients who received terlipressin | CTP at 30-, 90- and 365-d mortality 0.76, 0.75 and 0.72, respectively. CLIF-SOFA 0.66, 0.63, and 0.57. CLIF-C ACLF 0.60, 0.55, and 0.53. MELD 0.67, 0.64, and 0.5. MELD-Na 0.65, 0.63, and 0.52 | CTP was able to predict increased mortality at |
| Terres et al[40] | 2021 | Brazil | Evaluate the liver-specific scores to predict mortality | AOVH patients who received terlipressin | AUROC at 30- and 90-d: MELD-Na 0.77 and 0.78. CLIF-SOFA 0.76 and 0.75. CLIF-C AD or ACLF 0.64 and 0.60. MELD 0.75 and 0.77. CTP 0.75 and 0.76 | CLIF-SOFA was better in ACLF patients. CTP performed better in AD patients |
| Grochot et al[56] | 2019 | Brazil | Assess the validity of CLIF SOFA in predicting mortality and compare it to other liver-specific scores | AD and ACLF patients | AUROC at 28-, 90- and 365-d, respectively: CLIF-SOFA 0.71, 0.75 and 0.66. CLIF-C AD/ACLF 0.52, 0.51, and 0.56. MELD 0.54, 0.50, and 0.52. MELD-Na 0.57, 0.54, and 0.55 | CLIF-SOFA predicted 90-d mortality better than other scores |
| Jacques et al[69] | 2021 | Brazil | Evaluate the relation between ACLF and mortality | Cirrhotic patients with SBP | Scores for 28- and 90-d mortality, respectively: MELD 0.83 and 0.87. CLIF-SOFA 1.1 and 1.1. CTP 31 and 8.3 | Elevated CLIF-SOFA scores and the presence of ACLF were related to higher 28- and 90-d mortality |
| Engelmann et al[21] | 2018 | United Kingdom | Assess if the currently available scores can identify patients with ACLF | Patients with ACLF | AUROC of 28-d mortality prediction: CLIF-C ACLF 0.8. CLIF-C OF 0.75. MELD, 0.68. CP 0.66 | CLIF-C ACLF accurately predicted 28-d mortality |
| Barosa et al[70] | 2017 | Portugal | Evaluate CLIF-C ACLF, MELD, MELD-Na, and CTP scores for short/medium-term mortality, to identify ACLF frequency and to compare mortality between non-ACLF and ACLF patients | Patients admitted for AD of cirrhosis | Cut-off point in 28- and 90-d mortality, respectively: CLIF-C ACLF 50 and 50. CTP 10 and 10. MELD 17 and 14. MELD-Na 22 and 22 | CLIF-C ACLF score outperformed other scores |
| Ferreira Cardoso et al[71] | 2019 | Portugal | Validate the EASL-CLIF C scores | Patients with and without ACLF | AUROC for CLIF-C ACLF score for 28-d mortality was (0.856 ± 0.071) | CLIF-C AD score of 60 was related to an increased risk of developing ACLF |
| Maipang et al[57] | 2019 | Thailand | Assess ACLF prognostic models and investigation of their discriminative capacities in ACLF patients | Cirrhotic patients with AD and ACLF | Scores for 28-d, 90-d, 6-mo, and 1-yr mortality, respectively: CLIF-SOFA: 0.84, 0.85, 0.80, 0.80. CLIF-C OF: 0.83, 0.82, 0.78, and 0.78. CLIF-C ACLF: 0.79, 0.80, 0.77, and 0.77. CTP: 0.7, 0.67, 0.64, and 0.63. MELD: 0.63, 0.60, 0.56, and 0.56. MELD-Na: 0.63, 0.59, 0.56, and 0.56. iMELD: 0.73, 0.71, 0.67, and 0.68. APACHE II: 0.69, 0.65, 0.63, and 0.63 | The CLIF-SOFA had similar predictive accuracy for 28-d mortality as the CLIF-C OF |
| Li et al[36] | 2016 | China | Assess if CLIF-C OFs criteria can be used to identify patients and if the CLIF-C ACLF score can be used to predict prognosis | HBV cirrhotic patients with ACLF | Assess patients with ACLF for 28-, 90-, 180-, and 360-d mortality, respectively: HBV-ACLF: 0.654, 0.645, 0.644, and 0.640. CLIF-C ACLF: 0.704, 0.685, 0.687, and 0.682. MELD: 0.554, 0.543, 0.543, and 0.540. MELD-Na: 0.549, 0.541, 0.541, and 0.537. Patients without ACLF: for 28-, 90-, 180-, and 360-d mortality, respectively: HBV-AD: 0.737, 0.716, 0.720, and 0.721. CLIF-C AD: 0.733, 0.724, 0.728, and 0.728. MELD: 0.667, 0.653, 0.657, and 0.639. MELD-Na: 0.719, 0.710, 0.701, and 0.682 | CLIF-C ACLFs were found to be more accurate in predicting short-term mortality |
| Chirapongsathorn et al[49] | 2022 | Thailand | Collect epidemiological data and assess a scoring system for predicting mortality | ACLF patients. | AUROC of prognostic scores for 30- and 90-d mortality, respectively: CLIF-SOFA: 0.64 and 0.61 (95%CI: 0.585-0.704). CLIF-OF: 0.62 and 0.59. CLIF-C: 0.62 and 0.61. MELD: 0.60 and 0.56. MELD-Na: 0.60 and 0.57 | CLIF-SOFA score had a higher AUROC than the other scores |
| Zhang et al[31] | 2018 | China | Assess bacterial infection and predictors of mortality | ACLF patients with autoimmune liver disease | CLIF-SOFA score for 28-d mortality was 1.362 and 1.093, respectively.Scores for 90-d mortality were, respectively: CLIF-SOFA 2.936 and 1.578. MELD 1.232 and 0.664. CP 2.003 and 0.595 | All scores of ACLF patients with bacterial infection were high |
| Shin et al[72] | 2020 | South Korea | To look into the risk factors for mortality in cirrhotic patients and to see how ACLF affected their prognosis | Cirrhotic patients with variceal bleeding | Prediction of mortality at 28- and 90-d with AUROC were, respectively: CTP 0.842 and 0.846. MELD 0.857 and 0.867. MELD-Na 0.828 and 0.834. CLIF-SOFA 0.895 (95%CI, 0.829-0.962) and 0.897 (95%CI, 0.842-0.951) | CLIF-SOFA model well predicted 28-d or 90-d mortality |
| Gao et al[73] | 2018 | China | Investigate the CLIF-SOFA lung score's predictive value and determine the best voriconazole regimen | ACLF patients with IPA | CLIF-SOFA 10 (P = 0.083). CLIF-C ACLF 46.8 (P = 0.028). MELD 27.2 (P = 0.145). MELD-Na 28.6 (P = 0.064) | Patients with a CLIF-SOFA lung score of less than 2 had a superior 28-d survival rate than those with a lung score of more than 1 (P = 0.001) |
| Chen et al[74] | 2021 | China | Create a predictive nomogram | HBV-ACLF patients undergoing LT | CP score (0.626), MELD (0.627), MELD-Na (0.583), CLIF-C OF (0.674), and CLIF-C ACLF (0.684) | The nomogram's concordance index for predicting 1-yr survival was 0.707, which was significantly greater than that of other prognostic models. The nomogram could be helpful in determining which HBV-ACLF patients may improve after LT |
| Yu et al[75] | 2021 | China | Multicenter study to develop and evaluate a novel scoring system that uses baseline and dynamic data to predict short-term prognosis | ACLF patients | For 90-d prognosis: DP-ACLF with an AUC value of 0.907, CTP (0.601/74.6%), MELD (0.721/76.2%), MELD-Na (0.740/73.8%), CLIF-SOFA (0.701/76.9%), CLIF-C ACLF (0.694/74.6%), and COSSH-ACLF (0.724/77.7%) (P < 0.001) | The validation group had a higher predictive accuracy of DP-ACLF on ACLF prognosis and an accuracy rate of 85.4%, according to ROC analysis |
| Liu et al[35] | 2020 | China | Assess different prognostic models to predict short-term mortality | ACLF patients | The AUROCS of the CLIF-SOFA score, PWR, ALBI score, and MELD score was 0.804, 0.759, 0.710, and 0.670, respectively | CLIF-SOFA was the best model for predicting 28-d mortality |
| Zhang et al[76] | 2015 | China | Examine and contrast the various ACLF diagnostic criteria currently in use. Also, to identify predictors of the progress from ACLF at enrolment defined by APASL alone or by both APASL and CMA | Selected patients were cirrhotic, fulfilling at least APASL criteria for ACLF | CTP 12 and 11 (P = 0.53). MELD 17.8 and 16.0 (P = 0.02). MELD-Na 20.1 and 18.7 (P = 0.02). CLIF-SOFA 7 and 7 (P = 0.01) | The maximum rise in the CLIF-SOFA score, MELD-Na score, and total bilirubin were all independent predictors of progression into post-enrollment EASL-CLIF ACLF from ACLF at enrollment |
| Li et al[77] | 2020 | China | Randomized study to assess the scoring systems for predicting short-term results | HBV-ACLF patients | ALBI score (30-d mortality: HR = 3.452; 90-d mortality: HR = 3.822), MELD (30-d mortality: HR = 1.073; 90-d mortality: HR = 1.082), CLIF-C ACLF score (30-d mortality: HR = 1.061; 90-d mortality: HR = 1.065) | All scores accurately predicted 30-d and 90-d mortality. A higher CLIF-C ACLF score was linked to a lower overall survival rate |
| Zhang et al[14] | 2020 | China | Find prognostic scores that can be used to predict short- and long-term outcomes | ACLF patients with cirrhosis | Scores for survivors and [non-survivors] at 28-d, 3- and 6-mo, respectively: CTP 10 [12] (P = 0.001), 10 [11] (P = 0.028) and 10 [11] (P = 0.033). MELD 16 [24] (P = 0.004), 15 [23] (P = 0.001) and 15 [23] (p=0.002). MELD-Na 18 [24] (P = 0.081), 16.54 [23.27] (P = 0.011) and 17.27 [23] (P = 0.020). CLIF-C OF 9 [11] (P = < 0.001), 9 [10.00] (P = 0.001) and 9 [10] (P = 0.001). CLIF-SOFA 8 [12] (P ≤ 0.001), 8.55 [11.46] (P ≤ 0.001) and 8.53 [11.33] (P ≤ 0.001). CLIF-C ACLF 45.01 [53.98] (P ≤ 0.001), 44.39 [52.85] (P ≤ 0.001) and 44.11 [52.56] (P = 0.001) | The CLIF-SOFA score was particularly useful for assessing 28-d mortality |
| Kim et al[42] | 2016 | South Korea | A comparative study to evaluate the performance of suggested ACLF-specific scores in predicting short-term mortality | Alcoholic hepatitis patients | The AUROC of CLIF-SOFA, CLIF-C OFs, DF, ABIC, GAHS, MELD, and MELD-Na was 0.86 (0.81-0.90), 0.89 (0.84-0.92), 0.79 (0.74-0.84), 0.78 (0.72-0.83), 0.81 (0.76-0.86), 0.83 (0.78-0.88), and 0.83 (0.78-0.88), respectively, for 28-d mortality. CLIF-SOFA score of 8 had (78.1% Sn and 79.7% Sp), and CLIF-C OFs of 10 had (68.8% Sn and 91.4% Sp) for predicting 28-d mortality | CLIF-SOFA and CLIF-C OF scores performed well for short-term mortality |
| Costa E Silva et al[78] | 2021 | Brazil | Assess how well prognostic scores predict mortality | Cirrhotic patients admitted to the ICU | AUC revealed in all patients: CTP 0.701, APACHE II 0.695, MELD 0.727, MELD-Na 0.729, MESO index 0.723, iMELD 0.640, SOFA 0.753, CLIF-SOFA 0.776, CLIF-C OF 0.807 and CCI 0.627. CLIF-C OF in ACLF patients (0.749). CLIF-SOFA in AD patients (0.716) and CLIF-C AD (0.695) | CLIF-C OF and CLIF-SOFA had the best ability to predict mortality in all patients |
| Chen et al[38] | 2020 | Taiwan | Compare the eight prognostic scores | Cirrhotic patients with ACLF | Score on admission to ICU median (IQR) (P ≤ 0.001): CTP 9.0, MELD 23.0, CLIF-C OF 10.0, CLIF-C ACLF 49.2, SAP III 51.0, MPM0-III 0.0 (P = 0.001), APACHE II 16.0, and APACHE III 81.0. Predict overall mortality by AUROC: CTP 0.719, MELD 0.702, CLIF-C OF 0.721, CLIF-C ACLF 0.772, MPM0-III 0.607, SAP III 0.739, APACHE II 0.756 and APACHE III 0.817 | APACHE III and CLIF-C ACLF scores were superior to other models for predicting overall mortality |
| Sheng et al[79] | 2021 | China | Create a new and effective prognosis model and identify new prognostic factors | HRS with AD patients | AUROC in derivation and validation, respectively: GIMNS (0.830 and 0.732), MELD (0.759 and 0.623), CLIF-SOFA (0.767 and 0.661), COSSH-ACLF (0.759 and 0.674). Mortality at 28-d according to the developed GIMNS score: (GIMNS ≥ 2) 100.0%, (GIMNS 1-2) 73.8%, (GIMNS 0-1) 57.1% and (GIMNS < 0) 30.3% | GIMNS had a higher accuracy AUROC and outperformed MELD and CLIF-SOFA |
| Hong et al[80] | 2016 | South Korea | Evaluate the features and outcomes of ACLF patients | ACLF patients with underlying liver disease | Scores in Type A (non-cirrhosis), B (cirrhosis), and C (cirrhosis with the previous decompensation), respectively: MELD 29, 27 and 26. Hepatic CLIF-SOFA 19, 34 and 21. Extra-hepatic CLIF-SOFA 7, 11 and 31 | The 30-d overall survival rate for types A, B, and C, respectively, was 85.3%, 81.1%, and 83.7% |
| Sy et al[54] | 2016 | Canada | Assess if the CLIF-SOFA score could predict survival | Severely ill patients with ACLF | APACHE II 23; MELD 26; CTP 12; SOFA 15 and CLIF-SOFA 17. The CLIF-SOFA (AUROC 0.865). SOFA (AUROC 0.935) | CLIF-SOFA outperformed the other scores |
| Cai et al[2] | 2019 | China | Evaluate prognostic scoring models and create prediction models | Various causes of AD in cirrhotic patients | Hepatitis B group, AUROC for 28-d mortality for MELD, CLIF-C-AD, MELD-Na, AARC-ACLF, and the newly developed AD scores was 0.663, 0.673, 0.657, 0.662, and 0.773, respectively. Alcoholic liver disease group, 0.731, 0.737, 0.735, 0.689, and 0.778, respectively. Others group 0.765, 0.767, 0.814, 0.720, and 0.814, respectively | In predicting the prognosis of AD cirrhosis, the newly developed scoring models for short-term mortality outperformed the other models |
| Marciano et al[81] | 2017 | Argentina | Compare the predictive accuracy for 28- and 90-d transplant-free mortality of a modified CLIF-SOFA score with that of the classic CLIF-SOFA and KDIGO scores | AKI in cirrhotic patients with AD | Classic CLIF-SOFA and modified CLIF-SOFA by AUCROC: In 28-d transplant-free, 0.93 and 0.92 (P = 0.34), respectively. In 90-d transplant-free, 0.79 and 0.78 (P = 0.78), respectively. In AKI 28-d and 90-d transplant-free mortality by AUCROC, 0.67 (P = 0.002) and 0.63 (P = 0.02) | Both CLIF-SOFA scores were extremely accurate in predicting 28-d and 90-d transplant-free mortality |
| Xu et al[82] | 2018 | China | Recognizing mortality risk variables and optimizing stratification are crucial for increasing survival rates | Cirrhotic patients with pneumonia | Scores by AUROC for predicting mortality in 30-d and 90-d respectively: CLIF-SOFA 0.890 and 0.900. MELD 0.853 and 0.889. MELD-Na 0.801 and 0.849, qSOFA 0.854 and 0.777, PSI 0.867 and 0.831. CTP 0.726 and 0.768 | CLIF-SOFA outperformed the other models in predicting mortality |
| Silva et al[83] | 2021 | Brazil | Assess the prognostic scores predicting mortality | Cirrhotic patients who were admitted to the ICU without being pre-screened | ROC curves SOFA 0.88, MELD-Na 0.76, MELD 0.75, CPS 0.71 and SAPS 3 (0.51). In patients with ACLF, CLIF-ACLF 0.74, CLIF-OF 0.70, MELD-Na 0.73 and MELD 0.69, SAPS 3 (0.55), SOFA 0.63 and CLIF-SOFA 0.66 | In patients with and without ACLF, CLIF-ACLF and SOFA had higher accuracy in predicting mortality |
| McPhail et al[46] | 2015 | United Kingdom | Compare the capabilities of SOFA and CLIF-SOFA scores to predict patient survival and evaluate CLIF-SOFA | Cirrhotic patients | At the time of admission, with AUROC values, CLIF-SOFA and SOFA scores were 0.813 and 0.799, respectively. At 48 h after admission were 0.853 and 0.840, respectively. After 1 wk were 0.842 and 0.844, respectively | SOFA and CLIF-SOFA scores appear to have equal ability to predict patient survival |
| Yang et al[52] | 2022 | China | Estimate the short-term prognosis of ACLF patients | ACLF patients who had undergone LT | AUROC of MELDs 0.704, ABIC: 0.607, CLIF-C OFs 0.606, CLIF-C ACLFs 0.653 and CLIF-SOFAs 0.633 of the 90-d outcome | MELDs had a higher AUROC than others for predicting the 90-d outcome in ACLF patients after LT |
| Moreau et al[15] | 2013 | 12 European countries | Multicenter study to establish ACLF diagnostic criteria and characterize the progression of the disease | Cirrhotic patients with AD | The increased 28-d mortality rate was linked to three risk variables identified from the CLIF-SOFA score at enrollment: ≥ 2 organ failures, kidney failure alone, a combination of renal dysfunction, and a single organ failure other than kidney and/or hepatic encephalopathy (mild-moderate) | In patients with ACLF, higher CLIF-SOFA scores and leukocyte counts were predictors of mortality. The mortality rates at 28-d and 90-d, respectively: No ACLF 4.7% and 14%. ACLF g1: 22.1% and 40.7%. ACLF g2: 32% and 52.3%. ACLF g3: 76.7% and 79.1% |
| Li et al[37] | 2021 | China | Create a new simple prognostic score that can accurately predict outcomes | HBV-ACLF patients | The C-indices of the new score for 28- and 90-d mortality (0.826 and 0.809), COSSH-ACLF 0.793 and 0.784; CLIF-C ACLF 0.792 and 0.770; MELD 0.731 and 0.727; MELD-Na 0.730 and 0.726 (all P < 0.05) | The C-indices of the new score were significantly higher than other existing scores for 28-d and 90-d mortality |
| Perdigoto et al[58] | 2019 | Identify and characterize ACLF, and compare the CLIF-C OF score to the MELD-Na and the CP score. Also, to assess the CLIF-C ACLF and CLIF-C AD scores | Patients with ACLF | In the whole study group, the AUC: For 28-d mortality, the scores MELD, CLIF-C OF, and CP were 0.908, 0.844, and 0.753, respectively. For 90-d mortality 0.902, 0.814, and 0.724, respectively (P < 0.0001 for AUC in all scores) | CLIF-C OF shows good accuracy and diagnoses ACLF. MELD performed better in terms of 90-d mortality prediction | |
| Ramzan et al[84] | 2020 | Evaluate the CLIF-C CLF score and compare it to the MELD score | ACLF patients in ICU | MELD scores 30, 40 and 50 at 48 h were 0.532, 0.594 and 0.529, respectively. CLIF-C ACLF ≥ 70 at 0 h, 24 h, and 48 h were 0.498, 0.605, and 0.643, respectively | CLIF-C ACLF score of 70 or higher accurately predicts mortality | |
| Verma et al[85] | 2021 | Assess the prognostic models | ACLF patients | Day-7 AARC model had the numerically highest c-index, 0.872, best accuracy of 84.0%, Day-7 NACSELD-ACLF sensitivity (100%) but with a lower PPV (70%) for mortality | Patients having an AARC score of > 12 on day 7 had the lowest 30-d survival rate. All model performance parameters were better on day 7 | |
| Picon et al[59] | 2017 | Brazil | Assess prognostic scores | Patients with AD of cirrhosis and ACLF | Patients with ACLF, at 28-d from the diagnosis: CLIF-C ACLF with an AUC of 0.71. Patients with AD, regarding 28-d mortality: CLIF-C AD 0.75; CP 0.72; MELD 0.75; MELD-Na 0.76; CLIF-C OF 0.74. Patients with AD regarding 90-d mortality: CLIF-C AD 0.70; CP 0.73; MELD 0.7; MELD-Na 0.73; CLIF-C OF 0.65 | The CLIF-C ACLF score is the most accurate for predicting 28-d death in patients with ACLF. The CLIF-C AD score was also good in predicting death in cirrhosis with AD |
| Gupta et al[44] | 2017 | India | Assess the variations in mortality outcomes and predictors | Patients admitted with AD and ACLF caused by hepatic or extra-hepatic insults | AUROC for 28-d mortality in the extrahepatic ACLF group for CLIF-SOFA, MELD, iMELD, APACHE-11, and CTP was 0.788, 0.724, 0.718, 0.634, and 0.726, respectively. AUROC for 28-d mortality in the hepatic ACLF group for CLIF-SOFA, MELD, iMELD, APACHE-11, and CTP was 0.786, 0.625, 0.802, 0.761, and 0.648, respectively | iMELD and CLIF-SOFA were the best for predicting 28-d mortality |
| Niewiński et al[45] | 2020 | Poland | Use the available prognostic scores to find the best mortality risk factor(s) | Critically unwell ACLF patients | Predictive 90-d mortality: MELD 1.10, SOFA 1.33, CLIF-SOFA 1.40, and CLIF-C OF 1.64 | SOFA score surpassed the CLIF-C values |
| Kulkarni et al[55] | 2018 | India | Determine the in-hospital predictors of 28-d mortality | ACLF patients admitted to the Medical ICU | MELD 0.783 (Sn 75% and Sp 82.1%). CLIF-SOFA 0.947 (Sn 83.3% and Sp 96.4%). CTP 0.795 (Sn 94.4% and Sp 57.1%). APACHE-II 0.876 (Sn 91.6% and Sp 78.5%) | CLIF-SOFA and APACHE-II scores had a superior ability to predict mortality |
| Dhiman et al[86] | 2014 | India | Assess the efficacy of the CLIF-SOFA and APASL definitions of ACLF in predicting the short-term prognosis of ACLF patients | Patients selected were cirrhotic with AD | AUROCs for 28-d mortality were 0.795, 0.787, 0.739, and 0.710 for CLIF-SOFA, APACHE-II, CTP, and MELD, respectively | The strongest predictor of short-term mortality was the CLIF-SOFA score |
| Safi et al[87] | 2018 | Germany | Evaluate how infection detected at the time of admission, as well as other clinical baseline factors, affected the mortality | Cirrhotic patients with emergency admissions | Predictors of mortality up to 90 d (all patients): HR, 95%Cl, and P, respectively: SOFA 0.15, 0.03-0.69 and 0.015. CLIF C ACLF 1.09, 1.06-1.13 and < 0.001. Infection and CLIF-SOFA and infection and CLIF-C-ACLF: HR, 95%CI and P, respectively: CLIF-SOFA 1.33, 1.17- 1.51 and < 0.001 CLIF-SOFA: Infection 0.85, 0.71-1.02 and 0.074. CLIF-C-ACLF 1.09, 1.06-1.12 and < 0.001 CLIF-C-ACLF: Infection 0.96, 0.92-1.01 and 0.082 | Infection reduced the significant relation between mortality and CLIF-C-ACLF or CLIF-SOFA-score |
| Leão et al[88] | 2019 | Brazil | Assess how different ACLF diagnostic criteria performed in terms of predicting mortality | Cirrhotic patients with AD | AUROC at 28-d for CLIF-C, AARC and NACSELD criteria were 0.710, 0.560 and 0.561 (P = 0.002), respectively. AUROC at 90-d mortality were 0.760, 0.554 and 0.555 respectively (P < 0.001) | CLIF-C performed better in predicting mortality at 28-d and 90-d |
| Bartoletti et al[89] | 2018 | Different European countries | Summarize the current epidemiology of BSI, and assess predictors of 30-d mortality and antibiotic resistance risk factors | Cirrhotic patients | In a Cox regression model, CLIF-SOFA scores were (HR 1.35; 95%CI 1.28-1.43; P < 0.001) | The SOFA and CLIF-SOFA scores were the best predictors of 30-d mortality |
| Mendizabal et al[47] | 2021 | 11 Latin American countries | Evaluate whether SARS-CoV-2 infection affects the outcome and assess the effectiveness of the different prognostic models in predicting mortality | Hospitalized cirrhotic patients | AUROC for performance evaluation in predicting 28-d mortality for CLIF-C, NACSELD, CTP score and MELD-Na were 0.85, 0.75, 0.69, 0.67; respectively (P < 0.0001) | In patients with cirrhosis and SARS-CoV-2 infection, CLIF-C performed better than other models |
Table 5 Acute-on-chronic liver failure vs acute decompensation liver transplantation[45]
| Liver transplantation ACLF | Liver transplantation AD | P value | |
| Total | 22 (73.3%) | 7 (26.7%) | - |
| Age (yr) | 57.0 (IQR 11.0) | 54.0 (IQR 5.0) | n.s. |
| MELD | 30.7 (IQR 5.0) | 12.9 (IQR 7.3) | < 0.001 |
| iMELD | 53.1 (IQR 8.7) | 36.5 (IQR 15.6) | < 0.001 |
| MELD-Na | 34.4 (IQR 18.7) | 14.3 (IQR 17.6) | 0.002 |
| CPC | 13.0 (IQR 1.0) | 9.0 (IQR 3.0) | < 0.001 |
| SOFA | 8.0 (IQR 3.0) | 4.0 (IQR 3.0) | < 0.001 |
| CLIF-SOFA | 12.0 (IQR 3.0) | 5.0 (IQR 3.0) | < 0.001 |
| CLIF-C OF | 11.5 (IQR 2.0) | 7.0 (IQR 1.0) | < 0.001 |
- Citation: Rashed E, Soldera J. CLIF-SOFA and CLIF-C scores for the prognostication of acute-on-chronic liver failure and acute decompensation of cirrhosis: A systematic review. World J Hepatol 2022; 14(12): 2025-2043
- URL: https://www.wjgnet.com/1948-5182/full/v14/i12/2025.htm
- DOI: https://dx.doi.org/10.4254/wjh.v14.i12.2025