The Combined Clinical and Laboratory Index (CCLI) of Orrego et al was revised in 1983. It is intended to aid in the assessment of patients with alcoholic liver disease. Specific physical examination and laboratory test findings correlated with disease severity are scored and then summated to generate the CCLI. It can be used to predict patient mortality, to separate patients into cohorts based on severity of disease, and to compare different therapeutic interventions.
Patient Evaluation
|
Finding |
Definition |
Grade |
|---|---|---|
|
ascites |
abdominal distension, shifting dullness, flank dullness, and/or bulging, fluid wave and/or puddle sign |
+1 |
|
|
obvious distention of abdomen |
+2 |
|
|
very tense ascites with intra-abdominal organs not palpable |
+3 |
|
edema |
only slight pitting ankle edema |
+1 |
|
|
severe pitting edema of legs |
+2 |
|
|
generalized edema |
+3 |
|
collateral circulation |
visible veins mainly in the flanks or isolated in the anterior abdominal wall |
+1 |
|
|
a few prominent veins in the flanks and anterior abdominal wall |
+2 |
|
|
a large number of very prominent veins covering most of the abdominal wall |
+3 |
|
encephalopathy according to Adams and Foley (1949) |
clouded consciousness and impaired orientation with mild restlessness or agitation |
+1 |
|
|
drowsiness to stupor |
+2 |
|
|
deep coma |
+3 |
|
Findings Present or Absent |
Assessment |
|---|---|
|
Weakness |
Does the patient feel unduly tired on waking up or while performing light tasks? |
|
Anorexia |
Does the patient lack an appetite and eat less than normally? |
|
hepatomegaly |
number of centimeters below the right costal margin in the midclavicular line |
|
splenomegaly |
number of centimeters below the left costal margin |
|
palmar erythema |
|
|
gynecomastia (in males) |
|
Scoring Abnormalities
|
Abnormality |
Grade |
Score |
|---|---|---|
|
encephalopathy |
1 - 3 |
2 |
|
collateral circulation |
1 - 2 |
1 |
|
|
3 |
3 |
|
edema |
1 |
1 |
|
|
2 - 3 |
2 |
|
ascites |
1 - 3 |
2 |
|
spider nevi |
> 10 |
1 |
|
weakness |
present |
1 |
|
anorexia |
present |
1 |
|
(prothrombin time patient in seconds) - (PT control in seconds) |
4 - 5 |
1 |
|
|
> 5 |
2 |
|
hematocrit as percent of normal |
75 - 89.9% |
1 |
|
|
< 75% |
3 |
|
albumin in g/dL |
2.5 - 2.9 |
2 |
|
|
< 2.5 |
3 |
|
bilirubin mg/dL |
2.1 - 8 |
2 |
|
|
> 8 |
3 |
|
alkaline phosphatase in IU/L |
> 330 |
2 |
where:
• "normal" hematocrit used for calculation is lower limit of reference range; an alternative would be the mean of the reference range
• Caldwell et al (1993) modified the scoring criteria for prothrombin time and alkaline phosphatase to take into account differences in test and reporting methodologies.
CCLI =
= SUM (points for all abnormalities)
Interpretation:
• minimum score 0
• maximum score 25
|
Index |
1 years Mortality Rate |
|---|---|
|
0 |
0% |
|
1 - 5 |
5% |
|
6 - 10 |
20% |
|
11 - 15 |
60% |
|
16 - 20 |
90% |
|
21 - 25 |
100% |
Purpose: The use the revised Combined Clinical and Laboratory Index (CCLI) to evaluate a patient with alcoholic liver disease.
Specialty: Gastroenterology, Toxicology
Objective: severity, prognosis, stage
ICD-10: K70,
