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AST-to-Platelet Ratio Index (APRI Score)Acute Liver Failure Study Group Index (ALFSG Index)Age, Bilirubin, INR and Creatinine Score (ABIC Score)Albumin-Bilirubin Grade (ALBI Score)BMI, AST/ALT Ratio, and Diabetes Score (BARD Score)CLIF-C ACLF Score for Acute-on-Chronic Liver Failure (CLIF-C ACLF)CLIF-C AD Score for Acute Decompensation of Cirrhosis (CLIF-C AD)CLIF-SOFA Score for Organ Failure Assessment (CLIF-SOFA)Cancer of the Liver Italian Program Score (CLIP Score)Child-Pugh Classification for Cirrhosis (Child-Pugh)Chinese University Prognostic Index (CUPI Score)Fibrosis-4 Index (FIB-4 Index)Lille Model for Alcoholic Hepatitis (Lille Model)Maddrey Discriminant Function (Maddrey DF)Model for End-Stage Liver Disease (MELD Score)NAFLD Fibrosis Score (NFS)Simplified Autoimmune Hepatitis Score (Simplified AIH)
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CLIF-C ACLF Score for Acute-on-Chronic Liver Failure (CLIF-C ACLF)

CLIF-C ACLF Score for Acute-on-Chronic Liver Failure (CLIF-C ACLF)

ICU Mortality Risk Stratification

EASL-CLIF Consortium Metric (2014)

ACLF Engine

Calculate the ACLF score to predict mortality and triage transplant priority.

Guidelines & Evidence

Verified

Last Review: 2026-07-17

Clinical Significance

Defining ACLF

Acute-on-Chronic Liver Failure (ACLF) is a distinct clinical syndrome characterized by acute decompensation of cirrhosis, organ failure(s), and high short-term mortality. It is driven by systemic inflammation, often triggered by infection or alcohol.

Shortcomings of MELD

The MELD score focuses primarily on liver and kidney failure. ACLF involves failure of other systems (Brain, Circulation, Lungs) and intense inflammation (WCC), which MELD does not capture. The CLIF-C ACLF score provides the nuance required for the ICU setting.

Triage Utility

The score is used to identify three critical patient types: those needing urgent transplant, those who can recover with medical support, and those where intensive care is likely futile.

How it Works

The 6 Organ Failure Systems

Liver: Bilirubin thresholds.
Kidney: Creatinine or Renal Replacement Therapy.
Brain: West Haven Grade for Encephalopathy.
Coagulation: INR level.
Circulation: Mean Arterial Pressure (MAP) and Vasopressor need.
Lungs: PaO2/FiO2 or SpO2/FiO2 ratio.

The Final Formula

CLIF-C ACLF Score = 10 × [ 0.33 × CLIF-C OF + 0.04 × Age + 0.63 × ln(WBC count) - 2 ]

Mortality Stratification

Score < 39: < 15% mortality. Score > 64: > 80% mortality at 28 days.

Clinical Pearls

WBC as an Inflammatory Marker

A rapidly rising WBC, even without a clear source of infection, signifies the "cytokine storm" characteristic of ACLF. It is a critical multiplier in the prognostic formula.

Renal Priority

Renal failure is the most common organ failure in ACLF and carries the heaviest weighting in determining overall survival. Early initiation of albumin and terlipressin is mandatory.

The 48-Hour Trajectory

The score at 48 hours post-admission is often more predictive than the admission score, as it reflects the patient's response to initial resuscitation.

Next Steps

Grade 2-3 ACLF Management

Urgent evaluation for Liver Transplantation (Status 1A).
Broad-spectrum antibiotics for occult infection.
Aggressive ICU-level support (vasopressors, RRT if needed).
Nutritional support (35 kcal/kg).

Futility Assessment

If the score remains > 64 despite 72 hours of intensive care, survival even with transplant is very low. Discuss goals of care with the family and the multidisciplinary team.

The Evidence

The CANONIC Study

Acute-on-chronic liver failure is a distinct syndrome: The CANONIC study.

Moreau R et al. • Gastroenterology. 2013;Study of 1,343 patients that defined ACLF and the original CLIF-SOFA score.

Validation of the ACLF Score

The CLIF Consortium Acute-on-Chronic Liver Failure score.

Jalan R et al. • J Hepatol. 2014;Proved the CLIF-C ACLF score is significantly more accurate than MELD-Na in predicting short-term death.

Origins & History

The EASL-CLIF Consortium

Developed by a network of over 100 European liver centers. It transformed ACLF from a vague clinical observation into a rigorous, data-driven diagnostic entity.

Evolution from SOFA

By modifying the general ICU "SOFA" score to include liver-specific markers like INR and the West Haven scale, the consortium created a tool truly tailored for the cirrhotic patient.

Last Comprehensive Review: 2026-07-17

In Recent Clinical News

Scanning Medical Journals

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