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 is a syndrome characterized by decompensation in individuals with chronic liver disease, and is generally secondary to one or more extra-hepatic organ failures, implying an elevated mortality rate. Acute decompensation 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 acute-on-chronic liver failure (ACLF) in patients with or without acute decompensation (AD), classifying it into three grades.
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. Using 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 (MSc student), and a list of potentially eligible studies was generated based on the titles and abstracts screened.
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 studies' findings were based on an AUROC analysis, which revealed that the CLIF-SOFA, CLIF-C ACLF, and CLIF-C AD scores were preferable to other models in predicting 28-d mortality. They had the greatest AUROC scores predicting overall 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 could predict short-term and long-term mortality in patients with ACLF or AD in more than 50% of the articles found.
The CLIF-SOFA score surpassed other predictive models in predicting short-term prognosis in ACLF patients. CLIF-SOFA, CLIF-C ACLF, and CLIF-C AD are accurate in predicting scores for short-term and long-term mortality in patients with ACLF and in predicting adverse outcomes associated with chronic liver disease.
Within the included articles in this study from 2013 to 2022, CLIF-SOFA was superior to other scores for predicting mortality (mainly in the short-term) in ACLF patients in more than 50% of the included articles, followed by CLIF-C ACLF and CLIF-C AD (30% of the articles). CLIF-C OF was accurate at 10%. CTP accurately predicted the score for ACLF patients with HRS and AOVH patients with AD. The MELD score accurately predicted short-term mortality in ACLF patients who underwent LT.