title: CLIF-SOFA scoring system accurately predicts short-term mortality in acutely decompensated patients with alcoholic cirrhosis: a retrospective analysis.
abstract: OBJECTIVE
  Accurate prognostication of acute-on-chronic liver failure (ACLF) is essential for therapeutic decisions. Our aim was to validate a novel scoring system for predicting mortality, the chronic liver failure-sequential organ failure assessment (CLIF-SOFA), in a population of Asian patients with ACLF.
  
  
  METHODS
  A total of 345 patients with acutely decompensated alcoholic cirrhosis were selected for study, comparing areas under the receiver operating characteristic (AUROC) curves of CLIF-SOFA and five existing scoring systems for end-stage liver disease [model for end-stage liver disease (MELD), MELD-Na, Refit-MELD, Refit-MELD-Na, and Child-Turcotte-Pugh].
  
  
  RESULTS
  CLIF-SOFA displayed the highest AUROC of 0.943 significantly outperforming all five reference methods in predicting short-term mortality at Week 4 (all P < 0.001) by competing risk analysis. In 262 patients given supportive care only, the power of CLIF-SOFA to predict short-term mortality was high (AUROC: 0.952 at Week 1; 0.959 at Week 4), again surpassing the other methods (all P < 0.001). For the remaining 83 liver transplant recipients, CLIF-SOFA also excelled in predicting 12-week mortality (AUROC: 0.978); and high-grade ACLF by CLIF-SOFA was associated with prolonged postoperative mechanical support (i.e. mechanical ventilation and renal replacement therapy) and ICU stays (all P < 0.05).
  
  
  CONCLUSIONS
  CLIF-SOFA enables more accurate prediction of short-term mortality in patients with acutely decompensated alcoholic cirrhosis than other available scoring systems and is useful in predicting both 12-week mortality and the need for mechanical support after liver transplantation.
authors.affiliation: Department of Internal Medicine and Liver Research Institute, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Minjong
authors.initials: M
authors.lastname: Lee
authors.forename: Jeong-Hoon
authors.initials: JH
authors.lastname: Lee
authors.forename: Sohee
authors.initials: S
authors.lastname: Oh
authors.forename: Yoonhyuk
authors.initials: Y
authors.lastname: Jang
authors.forename: Wonik
authors.initials: W
authors.lastname: Lee
authors.forename: Hyung Joo
authors.initials: HJ
authors.lastname: Lee
authors.forename: Jeong-Ju
authors.initials: JJ
authors.lastname: Yoo
authors.forename: Won-Mook
authors.initials: WM
authors.lastname: Choi
authors.forename: Young Youn
authors.initials: YY
authors.lastname: Cho
authors.forename: Yuri
authors.initials: Y
authors.lastname: Cho
authors.forename: Dong Hyeon
authors.initials: DH
authors.lastname: Lee
authors.forename: Yun Bin
authors.initials: YB
authors.lastname: Lee
authors.forename: Su Jong
authors.initials: SJ
authors.lastname: Yu
authors.forename: Nam-Joon
authors.initials: NJ
authors.lastname: Yi
authors.forename: Kwang-Woong
authors.initials: KW
authors.lastname: Lee
authors.forename: Yoon Jun
authors.initials: YJ
authors.lastname: Kim
authors.forename: Jung-Hwan
authors.initials: JH
authors.lastname: Yoon
authors.forename: Kyung-Suk
authors.initials: KS
authors.lastname: Suh
authors.forename: Hyo-Suk
authors.initials: HS
authors.lastname: Lee
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality*; D019540:Area Under Curve; D005260:Female; D006801:Humans; D008104:Liver Cirrhosis, Alcoholic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D063305:Organ Dysfunction Scores; D011237:Predictive Value of Tests; D011379:Prognosis; D012372:ROC Curve; D056910:Republic of Korea; D012189:Retrospective Studies; D018709:Statistics, Nonparametric
keywords: CLIF-SOFA; acute-on-chronic liver failure; validation