BACKGROUND Acute-on-chronic liver failure(ACLF)is a syndrome characterized by decompensation in individuals with chronic liver disease,generally secondary to one or more extra-hepatic organ failures,implying an elevat...BACKGROUND Acute-on-chronic liver failure(ACLF)is a syndrome characterized by decompensation in individuals with chronic liver disease,generally secondary to one or more extra-hepatic organ failures,implying an elevated mortality rate.Acute decompensation(AD)is the term used for one or more significant consequences of liver disease in a short time and is the most common reason for hospital admission in cirrhotic patients.The European Association for the Study of Liver-Chronic-Liver Failure(EASL-CLIF)Group modified the intensive care Sequential Organ Failure Assessment score into CLIF-SOFA,which detects the presence of ACLF in patients with or without AD,classifying it into three grades.AIM To investigate the role of the EASL-CLIF definition for ACLF and the ability of CLIF-SOFA,CLIF-C ACLF,and CLIF-C AD scores for prognosticating ACLF or AD.METHODS This study is a literature review using a standardized search method,conducted using the steps following the guidelines for reporting systematic reviews set out by the PRISMA statement.For specific keywords,relevant articles were found by searching PubMed,ScienceDirect,and BioMed Central-BMC.The databases were searched using the search terms by one reviewer,and a list of potentially eligible studies was generated based on the titles and abstracts screened.The data were then extracted and assessed on the basis of the Reference Citation Analysis(https://www.referencecitationanalysis.com/).RESULTS Most of the included studies used the EASL-CLIF definition for ACLF to identify cirrhotic patients with a significant risk of short-term mortality.The primary outcome in all reviewed studies was mortality.Most of the study findings were based on an area under the receiver operating characteristic curve(AUROC)analysis,which revealed that CLIFSOFA,CLIF-C ACLF,and CLIF-C AD scores were preferable to other models predicting 28-d mortality.Their AUROC scores were higher and able to predict all-cause mortality at 90,180,and 365 d.A total of 50 articles were included in this study,which found that the CLIF-SOFA,CLIF-C ACLF and CLIF-C AD scores in more than half of the articles were able to predict short-term and long-term mortality in patients with either ACLF or AD.CONCLUSION CLIF-SOFA score surpasses other models in predicting mortality in ACLF patients,especially in the short-term.CLIF-SOFA,CLIF-C ACLF,and CLIF-C AD are accurate short-term and long-term mortality prognosticating scores.展开更多
文摘BACKGROUND Acute-on-chronic liver failure(ACLF)is a syndrome characterized by decompensation in individuals with chronic liver disease,generally secondary to one or more extra-hepatic organ failures,implying an elevated mortality rate.Acute decompensation(AD)is the term used for one or more significant consequences of liver disease in a short time and is the most common reason for hospital admission in cirrhotic patients.The European Association for the Study of Liver-Chronic-Liver Failure(EASL-CLIF)Group modified the intensive care Sequential Organ Failure Assessment score into CLIF-SOFA,which detects the presence of ACLF in patients with or without AD,classifying it into three grades.AIM To investigate the role of the EASL-CLIF definition for ACLF and the ability of CLIF-SOFA,CLIF-C ACLF,and CLIF-C AD scores for prognosticating ACLF or AD.METHODS This study is a literature review using a standardized search method,conducted using the steps following the guidelines for reporting systematic reviews set out by the PRISMA statement.For specific keywords,relevant articles were found by searching PubMed,ScienceDirect,and BioMed Central-BMC.The databases were searched using the search terms by one reviewer,and a list of potentially eligible studies was generated based on the titles and abstracts screened.The data were then extracted and assessed on the basis of the Reference Citation Analysis(https://www.referencecitationanalysis.com/).RESULTS Most of the included studies used the EASL-CLIF definition for ACLF to identify cirrhotic patients with a significant risk of short-term mortality.The primary outcome in all reviewed studies was mortality.Most of the study findings were based on an area under the receiver operating characteristic curve(AUROC)analysis,which revealed that CLIFSOFA,CLIF-C ACLF,and CLIF-C AD scores were preferable to other models predicting 28-d mortality.Their AUROC scores were higher and able to predict all-cause mortality at 90,180,and 365 d.A total of 50 articles were included in this study,which found that the CLIF-SOFA,CLIF-C ACLF and CLIF-C AD scores in more than half of the articles were able to predict short-term and long-term mortality in patients with either ACLF or AD.CONCLUSION CLIF-SOFA score surpasses other models in predicting mortality in ACLF patients,especially in the short-term.CLIF-SOFA,CLIF-C ACLF,and CLIF-C AD are accurate short-term and long-term mortality prognosticating scores.
