Published online Dec 27, 2022. doi: 10.4254/wjh.v14.i12.2025
Peer-review started: August 26, 2022
First decision: October 11, 2022
Revised: October 18, 2022
Accepted: November 7, 2022
Article in press: November 7, 2022
Published online: December 27, 2022
Acute-on-chronic liver failure (ACLF) is a syndrome characterized by de
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.
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 (https://www.referencecitationanalysis.com/).
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.
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.
Core Tip: Acute-on-chronic liver failure (ACLF) is a serious medical challenge worldwide, and its occurrence is a difficult clinical incident due to its severe presentation, quick disease course, and elevated short-term mortality. The European Association for the Study of Liver-Chronic-Liver Failure (EASL-CLIF) Consortium proposal has gained considerable acceptance as a diagnostic criteria for ACLF. CLIF-SOFA has increased the ability to detect patients with ACLF. Unless presenting with renal impairment and/or mild to moderate hepatic encephalopathy, cirrhotic patients with acute decompensation and single liver failure (or any other single "non-renal" organ failure) had a minimum mortality risk. These results suggest that CLIF-SOFA score surpasses other models in predicting mortality in ACLF patients, especially in the short-term.