Moreau et al reported grades of acute-on-chronic liver failure (ACLF). The grade correlates with mortality. The authors are from multiple institutions in Europe.
Patient selection: chronic liver disease
Parameters:
(1) non-cerebral organ failure (kidney, liver, coagulation, circulation, respiration)
(2) serum creatinine in mg/dL (renal dysfunction defined as 1.5 to 1.9 mg/dL)
(3) hepatic encephalopathy (moderate if Grade 1 or 2) or cerebral failure
Grade 0 ACLF:
(0A) (no non-cerebral organ failure) AND (serum creatinine < 1.5 mg/dL) AND (no hepatic encephalopathy)
(0B) (1 non-cerebral organ failure, not kidney) AND (serum creatinine < 1.5 mg/dL) AND (no hepatic encephalopathy)
(0C) (no non-cerebral organ failure) AND (serum creatinine < 1.5 mg/dL) AND (cerebral failure)
Grade 1 ACLF:
(1A) kidney failure only
(1B) (single non-cerebral organ failure other than kidney) AND ((serum creatinine 1.5 to 1.9 mg/dL) OR (mild to moderate hepatic encephalopathy))
(1C) (no non-cerebral organ failure) AND (serum creatinine 1.5 to 1.9 mg/dL) AND (cerebral failure)
Grade 2 ACLF:
(1) 2 organ failures
Grade 3 ACLF:
(1) >= 3 organ failures
|
Grade
|
28-day Mortality
|
90-day Mortality
|
|
0
|
5%
|
14%
|
|
1
|
22%
|
41%
|
|
2
|
32%
|
52%
|
|
3
|
77%
|
79%
|
