The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure

J Hepatol. 2015 Apr;62(4):831-40. doi: 10.1016/j.jhep.2014.11.012. Epub 2014 Nov 22.


Background & aims: Cirrhotic patients with acute decompensation frequently develop acute-on-chronic liver failure (ACLF), which is associated with high mortality rates. Recently, a specific score for these patients has been developed using the CANONIC study database. The aims of this study were to develop and validate the CLIF-C AD score, a specific prognostic score for hospitalised cirrhotic patients with acute decompensation (AD), but without ACLF, and to compare this with the Child-Pugh, MELD, and MELD-Na scores.

Methods: The derivation set included 1016 CANONIC study patients without ACLF. Proportional hazards models considering liver transplantation as a competing risk were used to identify score parameters. Estimated coefficients were used as relative weights to compute the CLIF-C ADs. External validation was performed in 225 cirrhotic AD patients. CLIF-C ADs was also tested for sequential use.

Results: Age, serum sodium, white-cell count, creatinine and INR were selected as the best predictors of mortality. The C-index for prediction of mortality was better for CLIF-C ADs compared with Child-Pugh, MELD, and MELD-Nas at predicting 3- and 12-month mortality in the derivation, internal validation and the external dataset. CLIF-C ADs improved in its ability to predict 3-month mortality using data from days 2, 3-7, and 8-15 (C-index: 0.72, 0.75, and 0.77 respectively).

Conclusions: The new CLIF-C ADs is more accurate than other liver scores in predicting prognosis in hospitalised cirrhotic patients without ACLF. CLIF-C ADs therefore may be used to identify a high-risk cohort for intensive management and a low-risk group that may be discharged early.

Keywords: Acute-on-chronic liver failure; Chronic liver failure; Hepatic encephalopathy.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute-On-Chronic Liver Failure
  • Adult
  • Aged
  • Creatinine / blood*
  • Disease Progression
  • Female
  • Hospitalization / statistics & numerical data
  • Humans
  • International Normalized Ratio*
  • Leukocyte Count*
  • Liver Cirrhosis* / diagnosis
  • Liver Cirrhosis* / mortality
  • Liver Cirrhosis* / physiopathology
  • Liver Cirrhosis* / therapy
  • Male
  • Middle Aged
  • Predictive Value of Tests
  • Prognosis
  • Reproducibility of Results
  • Research Design / standards
  • Risk Assessment / methods
  • Sodium / blood*
  • Survival Analysis


  • Sodium
  • Creatinine