Acute-on-chronic liver failure: Pathogenesis, prognostic factors and management

Table 1 Chronic liver failure-sequential organ failure assessment score

Organ failure	0	1	2	3	4
Liver (Tbil, mg/L)	< 1.2	≥ 1.2 to < 2.0	≥ 2.0 to < 6.0	≥ 6.0 to < 12	≥ 12.0
Kidney (cr, mg/dL)	< 1.2	≥ 1.2 to < 2.0	≥ 2.0 to < 3.5	≥ 6.0 to < 12	≥ 5.0
	Or use of renal replacement therapy
Cerebral (HE grade)	No HE	I	II	III	IV
Coagulation (INR)	< 1.1	≥ 1.1 to < 1.25	≥ 1.25 to < 1.5	≥ 1.5 to < 2.5	≥ 2.5 or PLT ≤ 20 × 109/L
Circulation (MAP, mmHg)	≥ 70	< 70	DA ≤ 5 or DOB or Terlipressin	DA > 5 or E ≤ 0.1 or NE ≤ 0.1	DA > 15 or E 0.1 or NE > 0.1
Lung PaO2/FiO2	> 400	> 300 to ≤ 400	> 200 to ≤ 300	> 100 to ≤ 200	≤ 100
Or SpO2/FiO2	> 512	> 357 to ≤ 512	> 214 to ≤ 357	> 89 to ≤ 214	≤ 89

This score is used to categorize patients into grades of ACLF. ACLF: Acute-on-chronic liver failure; CLIF: Chronic liver failure; SOFA: Sequential organ failure assessment; Tbil: Total bilirubin; cr: Serum creatinine; HE: Encephalopathy; INR: International normalized ratio; PLT: Plateletes; DA: Dopamine; DOB: Dobutamine; E: Epinephrine; NE: Norepinephrine; PaO₂: Partial pressure of arterial oxygen; FiO₂: Fraction of inspired oxygen; SpO₂: Pulse oximetry saturation. Data from Moreau et al[12].