Jalan et al reported the CLIF-C organ failure scoring system (OF). The authors are from multiple institutions in Europe and are members of the EASL-CLIF Consortium.
Patient selection: acute-on-chronic liver failure
Parameters:
(1) liver status based on serum total bilirubin in mg/dL
(2) kidney status based on serum creatinine in mg/dL or renal replacement
(3) brain status based on West-Haven grade of hepatic encephalopathy
(4) coagulation status based on INR or need for vasopressors
(5) circulatory status based on MAP in mm Hg
(6) respiratory status based on PaO2/FIO2 ratio or SpO2/FIO2 ratio or mechanical ventilation for respiratory failure
|
Parameter |
Finding |
Points |
|
serum total bilirubin |
< 6 mg/dL |
1 |
|
|
6 to 11.99 mg/dL |
2 |
|
|
>= 12 mg/dL |
3 |
|
kidney status |
creatinine < 2 mg/dL |
1 |
|
|
creatinine 2 to 3.49 mg/dL |
2 |
|
|
creatinine >= 3.5 mg/dL |
3 |
|
|
renal replacement |
3 |
|
hepatic encephalopathy |
Grade 0 |
1 |
|
|
Grades 1 or 2 |
2 |
|
|
Grade 3 or 4 (plus mechanical ventilation for HE) |
3 |
|
INR |
< 2.0 |
1 |
|
|
2.0 to 2.49 |
2 |
|
|
>= 2.5 |
3 |
|
MAP |
>= 70 mm Hg |
1 |
|
|
< 70 mm Hg |
2 |
|
|
need for vasopressors |
3 |
|
respiratory status |
PaO2/FIO2 > 300 |
1 |
|
|
PaO2/FIO2 201 - 300 |
2 |
|
|
PaO2/FIO2 <= 200 |
3 |
|
|
SpO2/FIO2 > 357 |
1 |
|
|
SpO2/FIO2 215-357 |
2 |
|
|
SpO2/FIO2 < 215 |
3 |
|
|
mechanical ventilation for respiratory failure |
3 |
total score =
= SUM(points for all 6 parameters)
Criteria for an organ failure:
(1) scored 3 points
(2) serum creatinne and scored 2 points
Interpretation:
• minimum total score: 6
• maximum total score: 18
• minimum number of organ failures: 0
• maximum number of organ failures: 6
• The higher the score the greater the risk of 28-day mortality.
Performance:
• The area under the ROC curve is 0.72.
Specialty: Gastroenterology
