Prediction of Futility of Intensive Care for a Patient with Acute-on-Chronic Liver Failure Using the CLIF-C ACLF Score

Patient selection: acute-on-chronic liver disease requiring ICU care

A CLIF-C ACLF score >= 70 after 48 hours of intensive care is associated with futility of further intensive care support, with a 28-day mortality rate of 100% (sensitivity 31%).

These patients may have:

(1) evidence of SIRS

(2) renal failure

Patients with a score less than 70 may not survive, but this group overlaps with survivors.

Other signs of a poor prognosis (from Table 1):

(1) MELD >= 30

(2) Child-Pugh class C

(3) >= 4 organ failures

(4) CLIF-C ACLF score 58 to 69

(5) serum total bilirubin >= 10 mg/dL

(6) INR >= 2.4