Modified EASL-CLIF criteria that is easier to use and perform better to prognosticate acute-on-chronic liver failure

Abstract

BACKGROUND We have recently shown that the European Association for the Study of the Liver-Chronic Liver Failure Consortium (EASL-CLIF) criteria showed a bettersensitivity to detect acute-on-chronic liver failure (ACLF) with a better prognosticcapability than the North American Consortium for the Study of End-Stage LiverDisease criteria.AIMTo simplify EASL-CLIF criteria for ease of use without sacrificing its sensitivityand prognostic capability.METHODSUsing the United Network for Organ Sharing data (January 11, 2016, to August31, 2020), we modified EASL-CLIF (mEACLF) criteria; the modified mEACLFcriteria included six organ failures (OF) as in the original EASL-CLIF, but renalfailure was defined as creatinine ≥ 2.35 mg/dL and coagulation failure wasdefined as international normalized ratio (INR) ≥ 2.0. The mEACLF grades (0, 1, 2,and ≥ 3) directly reflected the number of OF.RESULTSOf the 40357 patients, 14044 had one or more OF, and 9644 had ACLF grades 1-3by EASL-CLIF criteria. By the mEACLF criteria, 15574 patients had one or moreOF. The area under the receiver operating characteristic (AUROC) for 30-d allcausemortality by OF was 0.842 (95%CI: 0.831-0.853) for mEACLF and 0.835(95%CI: 0.824-0.846) for EASL-CLIF (P = 0.006), and AUROC for 30-d transplantfreemortality by OF was 0.859 (95%CI: 0.849-0.869) for mEACLF and 0.851(95%CI: 0.840-0.861) for EASL-CLIF (P = 0.001). The AUROC of 30-d all-cause mortality by ACLF grades was 0.842 (95%CI: 0.831-0.853) for mEACLF and 0.793 (95%CI: 0.781-0.806) for EASL-CLIF (P < 0.0001). The AUROC of 30-d transplant-free mortality by ACLF was0.859 (95%CI: 0.848-0.869) for mEACLF and 0.805 (95%CI: 0.793-0.817) for EASL-CLIF (P < 0.0001).CONCLUSIONOur study showed that EASL-CLIF criteria for ACLF grades could be simplified for ease of usewithout losing its prognostication capability and sensitivity © The Author(s) 2022.