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The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure
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BACKGROUND & AIMS: Cirrhotic patients with acute decompensation frequently develop acute-on-chronic liver failure (ACLF), which is associated with high mortality rates. Recently, a specific score for these patients has been developed using the CANONIC study database. The aims of this study were to develop and validate the CLIF-C AD score, a specific prognostic score for hospitalised cirrhotic patients with acute decompensation (AD), but without ACLF, and to compare this with the Child-Pugh, MELD, and MELD-Na scores. METHODS: The derivation set included 1016 CANONIC study patients without ACLF. Proportional hazards models considering liver transplantation as a competing risk were used to identify score parameters. Estimated coefficients were used as relative weights to compute the CLIF-C ADs. External validation was performed in 225 cirrhotic AD patients. CLIF-C ADs was also tested for sequential use. RESULTS: Age, serum sodium, white-cell count, creatinine and INR were selected as the best predictors of mortality. The C-index for prediction of mortality was better for CLIF-C ADs compared with Child-Pugh, MELD, and MELD-Nas at predicting 3- and 12-month mortality in the derivation, internal validation and the external dataset. CLIF-C ADs improved in its ability to predict 3-month mortality using data from days 2, 3-7, and 8-15 (C-index: 0.72, 0.75, and 0.77 respectively). CONCLUSIONS: The new CLIF-C ADs is more accurate than other liver scores in predicting prognosis in hospitalised cirrhotic patients without ACLF. CLIF-C ADs therefore may be used to identify a high-risk cohort for intensive management and a low-risk group that may be discharged early.
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JALAN, Rajiv, PAVESI, Marco, SALIBA, Faouzi, AMORÓS, Àlex, FERNÁNDEZ, Javier, HOLLAND-FISCHER, Peter, SAWHNEY, Rohit, MOOKERJEE, Rajeshwar p., CARACENI, Paolo, MOREAU, Richard, GINÈS I GIBERT, Pere, DURAND, François, ANGELI, Paolo, ALESSANDRIA, Carlo, LALEMAN, Wim, TREBICKA, Jonel, SAMUEL, Didier, ZEUZEM, Stefan, GUSTOT, Thierry, GERBES, Alexander l., WENDON, Julia, BERNARDI, Mauro, ARROYO, Vicente. The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure. _Journal of Hepatology_. 2015. Vol. 62, núm. 4, pàgs. 831-840. [consulta: 21 de gener de 2026]. ISSN: 0168-8278. [Disponible a: https://hdl.handle.net/2445/125144]