The CLIF-C OF score includes the revised six organ systems of the CLIF-SOFA score. The CLIF-SOFA score was computed as the sum of the scores for six organ systems, including the cardiovascular, hepatic, coagulation, respiratory, nervous, and renal systems ( Moreau et al., 2013). The MELD-Na score was calculated as below: MELD–Na = (0.025 × MELD × (140–Na)) + 140 ( Kim et al., 2008). The MELD formula was: 3.8 × log (bilirubin) + 9.6 × log (creatinine) + 11.2 × log (INR) + 6.43 ( Kamath et al., 2001). The Child-Pugh score was computed based on albumin, ascites, HE, prothrombin time (PT), and serum bilirubin ( Pugh et al., 1973). The ACLF grading system classifies patients with ACLF in 1 of 3 grades according to the number of organ failures as per the CLIF-SOFA score as follows: Grade 1 if (1) single kidney failure (serum creatinine level ≥2.0 mg/dl) or (2) another organ failure (respiration, circulation, coagulation, or liver) is accompanied by grade I–II (West Haven criteria) hepatic encephalopathy (HE) and/or a serum creatinine level of 1.5–1.9 mg/dl, or (3) single cerebral failure (grade III–IV HE) is present with a serum creatinine level of 1.5–1.9 mg/dl grade 2 if 2 organ failures are identified or grade 3 if 3 or more organ failures have been diagnosed. The ACLF criteria and organ failures were defined based on the CLIF-SOFA score according to the EASL-CLIF Consortium. Our study was designed to assess the short-term and long-term discriminative power of all of the above scores in ACLF patients to direct clinical practice.Ĭirrhosis was defined by laboratory tests, radiologic imaging, endoscopy or liver biopsy. Up to now, there are less study on comparing all methods for the evaluation and prediction of prognosis in ACLF patients with a variety of etiologies, especially among Asians. ![]() The CLIF-C ACLF score not only assesses the effects of extrahepatic organ injury, coagulation and circulatory failure but also includes age and inflammatory indicators the CLIF-C ACLF score has high clinical value for evaluating the prognosis of ACLF. (2014) found that age and white blood cell (WBC) count were independent risk factors for mortality and established the CLIF-C ACLF score. The EASL-CLIF consortium also developed the CLIF consortium organ failure score (CLIF-C OF), which simplified the original CLIF-SOFA. In the EASL-CLIF ACLF in cirrhosis (CANONIC) study, ACLF was defined using a novel scoring system called the CLIF-sequential organ failure assessment score (CLIF-C SOFA), which is a modification of the original SOFA score. The MELD combined with serum sodium concentration (MELD-Na) score is related to the MELD score and has improved prognostic efficacy in cirrhotic patients awaiting liver transplantation ( Kim et al., 2008). Wiesner’s research analyzed data and established the Model for End-Stage Liver Disease (MELD) score the MELD score is superior to the CTP score with regard to the prediction of 3-month mortality in patients with chronic end-stage liver disease ( Wiesner et al., 2003). The Child-Turcotte-Pugh (CTP) score was first established as a widely utilized liver-specific score nearly 50 years ago ( Pugh et al., 1973). Some prognostic scores have been established previously. ![]() So, it is essential to develop an applicable prognostic score to estimate the outcomes in ACLF patients and help guide doctors in determining the treatment options according to the predicted outcomes. ACLF patients perform obvious differences in accordance with morbidity and survival. ACLF causes a heavy economic burden on patients. Although treatments such as liver transplantation and hemodialysis markedly improve survival in the short term, they are not extensively obtainable in clinical practice because of their high costs, the limited availability of liver resources, and the need for hospitalization. The basic etiology of ACLF is mainly alcoholism in European and American countries however, hepatitis virus infection is the leading etiology of ACLF in Asian countries, especially in China ( Zhao et al., 2018). Patients with chronic liver disease may progress to liver failure induced by enhanced viral replication, combined with bacterial or fungal infection and liver injury due to drug abuse or alcoholism ( Biggins et al., 2018). Patients diagnosed with ACLF often have multiple organ failures and high short-term mortality ( Bernal et al., 2015). Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized by the rapid deterioration of liver function due to acute injury.
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