title: The CLIF Consortium Acute Decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure.
abstract: OBJECTIVE
  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.
authors.affiliation: Liver Failure Group, Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom.
authors.forename: Rajiv
authors.initials: R
authors.lastname: Jalan
authors.affiliation: Data Management Center, EASL-CLIF Consortium, Barcelona, Spain.
authors.forename: Marco
authors.initials: M
authors.lastname: Pavesi
authors.affiliation: Hôpital Paul Brousse, Villejuif, France.
authors.forename: Faouzi
authors.initials: F
authors.lastname: Saliba
authors.affiliation: Data Management Center, EASL-CLIF Consortium, Barcelona, Spain.
authors.forename: Alex
authors.initials: A
authors.lastname: Amorós
authors.affiliation: Hospital Clínic, University of Barcelona, IDIBAPS, CIBEReHD, IRSIN, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Fernandez
authors.affiliation: Liver Failure Group, Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom.
authors.forename: Peter
authors.initials: P
authors.lastname: Holland-Fischer
authors.affiliation: Liver Failure Group, Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom.
authors.forename: Rohit
authors.initials: R
authors.lastname: Sawhney
authors.affiliation: Liver Failure Group, Institute for Liver and Digestive Health, Royal Free Hospital, London, United Kingdom.
authors.forename: Rajeshwar
authors.initials: R
authors.lastname: Mookerjee
authors.affiliation: Policlinico St Orsola Malpighi, Bologna, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Caraceni
authors.affiliation: Hopital Beaujon, Clichy, France.
authors.forename: Richard
authors.initials: R
authors.lastname: Moreau
authors.affiliation: Hospital Clínic, University of Barcelona, IDIBAPS, CIBEReHD, IRSIN, Spain. Electronic address: PGINES@clinic.ub.es.
authors.forename: Pere
authors.initials: P
authors.lastname: Ginès
authors.affiliation: Hôpital Paul Brousse, Villejuif, France.
authors.forename: Francois
authors.initials: F
authors.lastname: Durand
authors.affiliation: University of Padua, Padova, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Angeli
authors.affiliation: University of Turin, Torino, Italy.
authors.forename: Carlo
authors.initials: C
authors.lastname: Alessandria
authors.affiliation: University Hospital Gasthuisberg, Leuven, Belgium.
authors.forename: Wim
authors.initials: W
authors.lastname: Laleman
authors.affiliation: University Hospital Bonn, Bonn, Germany.
authors.forename: Jonel
authors.initials: J
authors.lastname: Trebicka
authors.affiliation: Hôpital Paul Brousse, Villejuif, France.
authors.forename: Didier
authors.initials: D
authors.lastname: Samuel
authors.affiliation: J.W Goethe University Hospital, Frankfurt, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Zeuzem
authors.affiliation: Erasme Hospital Brussels, Brussels, Belgium.
authors.forename: Thierry
authors.initials: T
authors.lastname: Gustot
authors.affiliation: University of Munich, Klinikum der LMU, Munich, Germany.
authors.forename: Alexander L
authors.initials: AL
authors.lastname: Gerbes
authors.affiliation: King's College Hospital, London, United Kingdom.
authors.forename: Julia
authors.initials: J
authors.lastname: Wendon
authors.affiliation: EASL-CLIF Consortium, Barcelona, Spain.
authors.forename: Mauro
authors.initials: M
authors.lastname: Bernardi
authors.affiliation: EASL-CLIF Consortium, Barcelona, Spain.
authors.forename: Vicente
authors.initials: V
authors.lastname: Arroyo
mesh_terms: D065290:Acute-On-Chronic Liver Failure; D000328:Adult; D000368:Aged; D003404:Creatinine / Q000097:blood*; D018450:Disease Progression; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D019934:International Normalized Ratio; D007958:Leukocyte Count; D008103:Liver Cirrhosis / Q000175:diagnosis / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D015203:Reproducibility of Results; D012107:Research Design / Q000592:standards; D018570:Risk Assessment / Q000379:methods; D012964:Sodium / Q000097:blood*; D016019:Survival Analysis
chemical_list: D012964:Sodium; D003404:Creatinine
keywords: Acute-on-chronic liver failure; Chronic liver failure; Hepatic encephalopathy