CLIF-SOFA and CLIF-C scores for the prognostication of acute-on-chronic liver failure and acute decompensation of cirrhosis: A systematic review

Abstract

BACKGROUND Acute-on-chronic liver failure (ACLF) is a syndrome characterized by decompensation in individuals with chronic liver disease, generally secondary to one or more extra-hepatic organ failures, implying an elevated mortality rate. Acute decompensation (AD) is the term used for one or more significant consequences of liver disease in a short time and is the most common reason for hospital admission in cirrhotic patients. The European Association for the Study of Liver-Chronic-Liver Failure (EASL-CLIF) Group modified the intensive care Sequential Organ Failure Assessment score into CLIF-SOFA, which detects the presence of ACLF in patients with or without AD, classifying it into three grades . AIM To investigate the role of the EASL-CLIF definition for ACLF and the ability of CLIF-SOFA, CLIF-C ACLF, and CLIF-C AD scores for prognosticating ACLF or AD. METHODS This study is a literature review using a standardized search method, conducted using the steps following the guidelines for reporting systematic reviews set out by the PRISMA statement. For specific keywords, relevant articles were found by searching PubMed, ScienceDirect, and BioMed Central-BMC. The databases were searched using the search terms by one reviewer, and a list of potentially eligible studies was generated based on the titles and abstracts screened. The data were then extracted and assessed on the basis of the Reference Citation Analysis ( ). RESULTS Most of the included studies used the EASL-CLIF definition for ACLF to identify cirrhotic patients with a significant risk of short-term mortality. The primary outcome in all reviewed studies was mortality. Most of the study findings were based on an area under the receiver operating characteristic curve (AUROC) analysis, which revealed that CLIF-SOFA, CLIF-C ACLF, and CLIF-C AD scores were preferable to other models predicting 28-d mortality. Their AUROC scores were higher and able to predict all-cause mortality at 90, 180, and 365 d. A total of 50 articles were included in this study, which found that the CLIF-SOFA, CLIF-C ACLF and CLIF-C AD scores in more than half of the articles were able to predict short-term and long-term mortality in patients with either ACLF or AD. CONCLUSION CLIF-SOFA score surpasses other models in predicting mortality in ACLF patients, especially in the short-term. CLIF-SOFA, CLIF-C ACLF, and CLIF-C AD are accurate short-term and long-term mortality prognosticating scores.

Clinical Profile, Short-term Prognostic Accuracies of CLIF-C ACLF Score and Serial CLIF-C OF Scores in Acute-on-chronic Liver Failure Patients: A Prospective Observational Study

“…In addition to the CLIF-C OF score, age and total leukocyte count were considered in the computation of this score. 8 …”

Management of sepsis in a cirrhotic patient admitted to the intensive care unit: A systematic literature review

“…The use of EASL-CLIF criteria on ACLF and CLIF-SOFA for prognostication of sepsis in cirrhotic patients admitted to the ICU has gained significant attention[ 8 , 38 ]. These scoring systems have been developed to assess the severity of liver disease and predict mortality in severely decompensated cirrhosis patients[ 39 - 42 ].…”

“…By incorporating organ failure parameters, such as cardiovascular, renal, respiratory, neurological, hematological, and hepatic dysfunction, these criteria provide a comprehensive evaluation of the patient's condition. In the context of sepsis, the EASL-CLIF criteria can help identify cirrhotic patients at higher risk of poor outcomes and guide clinicians in making informed decisions regarding treatment strategies and resource allocation[ 8 , 38 ]. The CLIF-SOFA score, in particular, has shown promise in predicting short-term mortality and facilitating risk stratification in this vulnerable population[ 29 , 43 - 45 ].…”

“…Cirrhosis is an irreversible condition caused by several factors or conditions, such as viral hepatitis, alcoholic liver disease, and non-alcoholic fatty liver disease. According to the World Health Organization, cirrhosis was the 9th leading cause of death in the west in 2015[ 8 ]. Studies have shown that mortality among cirrhotic patients with sepsis in the ICU ranges from 18%-66%, with mechanical ventilation being an independent predictor of mortality.…”

Acute on Chronic Liver Failure: Lessons from a Decade of EASL-CLIF Definition and Scoring Systems

“…A recent systematic review published in December 2022 looked at 50 studies from all over the world including India concluded the superiority of CLIF-SOFA OF score and CLIF-C ACLF score in predicting short-term outcomes. 7 …”