A HDL-based cirrhosis risk score improves the prediction of short-term mortality in acutely decompensated cirrhosis

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Updated: May 28, 2026

Cutoff Value of Phase Angle by Bioelectrical Impedance Analysis at Admission as a Prognostic Factor in Patients with Acute Heart Failure
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Published on: June 10, 2025

Rudolf E Stauber1, Eva M Usón-Raposo2, Florian Rainer1

  • 1Division of Gastroenterology and Hepatology, Department of Internal Medicine, Medical University of Graz, Graz, Austria.

Liver Transplantation : Official Publication of the American Association for the Study of Liver Diseases and the International Liver Transplantation Society
|May 27, 2026
PubMed

Insights

A new prognostic model, the CLIF-C HDL score, accurately predicts short-term mortality in patients with acutely decompensated cirrhosis using high-density lipoprotein cholesterol (HDL-C) and other blood markers. This score outperforms existing models in survival prediction.

Area of Science:

  • Hepatology
  • Clinical Biochemistry
  • Prognostic Modeling

Background:

  • Liver failure significantly alters lipid profiles, notably reducing high-density lipoprotein cholesterol (HDL-C), which has prognostic implications.
  • Acutely decompensated (AD) cirrhosis patients exhibit severe lipid alterations, impacting survival.
  • Existing prognostic models may not fully capture the predictive value of lipid markers in AD cirrhosis.

Purpose of the Study:

  • To develop an optimized prognostic model for survival prediction in AD cirrhosis patients.
  • To integrate high-density lipoprotein cholesterol (HDL-C) with other accessible blood parameters for enhanced prognostic accuracy.
  • To evaluate the performance of the novel prognostic model against established scores.

Main Methods:

  • High-density lipoprotein cholesterol (HDL-C) was measured in plasma samples from large prospective cohorts (CANONIC, PREDICT).
  • Multivariable competing risk analysis was employed, with death as the event and liver transplantation as a competing risk.
  • Cox proportional hazards regression was used to construct the CLIF-C HDL score, validated using C-index and Integrated Discrimination Index.

Main Results:

  • The analysis included 1035 patients with AD/ACLF, predominantly male with alcoholic etiology.
  • Six independent prognostic variables (age, HDL-C, creatinine, sodium, WBC, INR) formed the CLIF-C HDL score.
  • The CLIF-C HDL score demonstrated superior 90-day mortality prediction (C-index 0.768) compared to MELDNa (0.735) and MELD 3.0 (0.738), confirmed in external cohorts.

Conclusions:

  • The novel CLIF-C HDL score provides superior accuracy in predicting short-term mortality for patients with AD cirrhosis.
  • This model integrates readily available blood parameters, including HDL-C, for improved prognostic assessment.
  • The CLIF-C HDL score offers a more precise tool for clinical decision-making in managing AD cirrhosis.

Keywords:
CLIF-C ACLF scoreCLIF-C AD scoreHDL-CMELDMELD 3.0MELD-Nacholesterol

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