The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure

Jalan, Rajiv; Pavesi, Marco; Saliba, Faouzi; Amorós, Alex; Fernandez, Javier; Holland-Fischer, Peter; Sawhney, Rohit; Mookerjee, Rajeshwar; Caraceni, Paolo; Moreau, Richard; Ginès, Pere; Durand, Francois; Angeli, Paolo; Alessandria, Carlo; Laleman, Wim; Trebicka, Jonel; Samuel, Didier; Zeuzem, Stefan; Gustot, Thierry; Gerbes, Alexander L; ... (2015). The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure. Journal of hepatology, 62(4), pp. 831-840. Elsevier 10.1016/j.jhep.2014.11.012

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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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