The Chronic Liver Failure (CLIF Sequential Organ Failure Assessment (SOFA) score is a modification of the SOFA score for patients with chronic liver disease. This can help to identify a patient with cirrhosis who may benefit from more aggressive management. The authors are from Chang Gung Memorial Hospital in Taiwan.
Patient selection: cirrhosis in ICU
Parameters:
(1) PaO2 to FIO2 ratio OR SpO2 to FIO2 ratio
(2) INR or platelet count per µL
(3) serum bilirubin in mg/dL
(4) hypotension
(5) hepatic encephalopathy grade
(6) serum creatinine in mg/dL as measure of renal function
Differences from SOFA:
(1) option of SIO2 to FIO2 ratio
(2) INR instead of platelet count
(3) hepatic encephalopathy instead of Glasgow coma score
(4) terlipressin in hypotension
(5) removal of urine output and addition of renal replacement therapy (RRT)
|
Parameter |
Finding |
Points |
|
PaO2 to FIO2 ratio |
> 400 mm Hg |
0 |
|
|
301 – 400 mm Hg |
1 |
|
|
201 – 300 mm Hg |
2 |
|
|
101 – 200 mm Hg |
3 |
|
|
<= 100 mm Hg |
4 |
|
INR |
< 1.1 |
0 |
|
|
1.1 to 1.24 |
1 |
|
|
1.25 to 1.49 |
2 |
|
|
1.5 to 2.4 |
3 |
|
|
>= 2.5 |
4 |
|
|
platelet count < = 20,000 per µL |
4 |
|
serum bilirubin |
< 1.2 mg/dL |
0 |
|
|
1.2 – 1.9 mg/dL |
1 |
|
|
2.0 – 5.9 mg/dL |
2 |
|
|
6.0 – 11.9 mg/dL |
3 |
|
|
>= 12.0 mg/dL |
4 |
|
hypotension |
mean arterial pressure >= 70 mm Hg |
0 |
|
|
mean arterial pressure < 70 mm Hg, no pressor agents used |
1 |
|
|
dobutamine, any dose |
2 |
|
|
terlipressin |
2 |
|
|
dopamine <= 5 µg per kg per min |
2 |
|
|
dopamine > 5 to 15 µg per kg per min |
3 |
|
|
dopamine > 15 µg per kg per min |
4 |
|
|
epinephrine <= 0.1 µg per kg per min |
3 |
|
|
epinephrine > 0.1 µg per kg per min |
4 |
|
|
norepinephrine <= 0.1 µg per kg per min |
3 |
|
|
norepinephrine > 0.1 µg per kg per min |
4 |
|
encephalopathy |
none |
0 |
|
|
Grade I |
1 |
|
|
Grade II |
2 |
|
|
Grade III |
3 |
|
|
Grade IV |
4 |
|
serum creatinine or urine output |
serum creatinine < 1.2 mg/dL |
0 |
|
|
serum creatinine 1.2 – 1.9 mg/dL |
1 |
|
|
serum creatinine 2.0 – 3.4 mg/dL |
2 |
|
|
serum creatinine 3.5 – 4.9 mg/dL |
3 |
|
|
renal replacement therapy |
3 |
|
|
serum creatinine >= 5.0 mg/dL |
4 |
where:
• PaO2 is in mm Hg and FIO2 in percent from 0.21 to 1.00.
• Adrenergic agents as administered for at least 1 hour with doses in µg per kg per min.
• A score of 0 indicates normal and a score of 4 indicates most abnormal.
• Data can be collected and the score calculated daily during the course of the admission.
|
Parameter |
Finding |
Points |
|
SpO2 to FIO2 ratio |
> 512 mm Hg |
0 |
|
|
358 to 512 mm Hg |
1 |
|
|
215 to 357 mm Hg |
2 |
|
|
90 to 214 mm Hg |
3 |
|
|
<= 89 mm Hg |
4 |
mean systemic arterial pressure in mm Hg =
= ((systolic systemic arterial pressure in mm Hg) + (2 * (diastolic systemic arterial pressure in mm Hg))) / 3
total SOFA score =
= SUM(points for all 6 measures)
Interpretation:
• minimum total score: 0
• maximum total score: 24
• The higher the organ score, the greater the organ dysfunction.
• A CLIF-SOFA score on ICU admission > 11 was associated with a worse 6-month mortality rate (3% vs 52% if <= 11).
Performance:
• A CLIF-SOFA > 11 had a sensitivity of 76% and specificity of 93% with Youden index of 0.69.
• The overall correctness was 85%.
Specialty: Critical Care, Emergency Medicine, Gastroenterology
