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Published on: November 27, 2019
A Systematic Review and Meta-analysis on CLIF C ACLF Score in Predicting Short-term Mortality in Patients with Acute
Sugan Panneerselvam1, Jayakrishna Pamarthi1, Joy Varghese2
1Department of General Medicine, SRM Medical College Hospital and Research Centre, SRM Institute of Science and Technology, Kattankulathur 603203, Tamil Nadu, India.
Background:
Acute-on-chronic liver failure (ACLF) is a syndrome in cirrhotic patients characterized by high short-term mortality. This study systematically reviews the chronic liver failure consortium (CLIF-C) ACLF score, a validated tool for predicting short-term mortality in transplant-free ACLF patients.
Methods:
Following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, a systematic review and meta-analysis were conducted to evaluate the prognostic accuracy of the CLIF-C ACLF score in predicting 28-day and 90-day mortality among ACLF patients. A comprehensive search of PubMed and Scopus from inception to 24th August 2024 was conducted to identify studies reporting CLIF-C ACLF score in patients (≥18 years) diagnosed with ACLF. Data extraction and risk of bias assessment followed standardized protocols. A random-effects model was used to pool the mean score differences between transplant-free survivors and nonsurvivors, as well as area under the receiver operating characteristic curve (AUROC) and odds ratios (ORs) for 28- and 90-day mortality.
Findings:
Of 552 studies screened, 62 met inclusion criteria for the review, and 54 were included in the meta-analysis. The CLIF-C ACLF score was significantly higher in nonsurvivors ACLF patients, with a pooled mean difference of 28-day mortality -11.31 (95% CI: -15.53 to -7.09; I2 = 98.84%) and 90-day mortality -7.12 (95% CI:-8.34 to -5.90, I2 80.88%) P < 0.001. The score showed good predictive ability, with pooled AUROC of 0.79 (95% CI: 0.77 to 0.81, I2 = 66.9%) P < 0.001 for 28-day and 0.76 (95% CI: 0.72 to 0.80, I2 = 76%) P < 0.001 for 90-day mortality. The pooled OR for CLIF-C score, as a predictive risk factor for 28-day mortality, was 1.08 (95% CI: 1.00 to 1.17, I2 = 88%) P < 0.001, and 90-day mortality, was 1.18 (95% CI: 1.13 to 1.23, I2 = 0%) P = 0.887.
Conclusion:
The CLIF-C ACLF score demonstrates a good predictive ability for 28-day and 90-day short-term mortality in ACLF patients.
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