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Related Experiment Video

Updated: Jun 12, 2026

A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
12:24

A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma

Published on: September 30, 2021

Consensus versus Outcome-based Definitions of Acute-on-chronic Liver Failure: Implications for Risk Stratification

Nipun Verma1, Tingting Qi2,3, Pratibha Garg1

  • 1Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.

Journal of Clinical and Translational Hepatology
|June 11, 2026
PubMed
Summary
This summary is machine-generated.

The A-TANGO classification identifies more patients with acute-on-chronic liver failure (ACLF) than the consensus definition, including high-risk individuals missed by the consensus criteria. A-TANGO demonstrates superior sensitivity and risk stratification for ACLF patients.

Keywords:
Acute-on-chronic liver failureLiver cirrhosisMortalityMultiple organ failureRisk assessmentSensitivity and specificity

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Last Updated: Jun 12, 2026

A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma
12:24

A Three-Dimensional Spheroid Model to Investigate the Tumor-Stromal Interaction in Hepatocellular Carcinoma

Published on: September 30, 2021

Area of Science:

  • Hepatology
  • Clinical Medicine
  • Critical Care Medicine

Background:

  • Acute-on-chronic liver failure (ACLF) lacks a standardized definition, impacting clinical practice and research.
  • Recent consensus efforts propose new criteria for ACLF diagnosis.
  • Comparing existing and novel frameworks is crucial for accurate patient identification and management.

Purpose of the Study:

  • To compare the clinical validity of a proposed consensus ACLF framework against the outcome-calibrated A-TANGO classification.
  • To evaluate how each definition impacts patient classification and mortality risk assessment.

Main Methods:

  • A multinational cohort study involving 2,398 patients (TIH cohort, India) and 2,568 patients (CATCH-LIFE cohort, China) hospitalized with acute decompensation of cirrhosis.
  • ACLF was defined using both the A-TANGO classification and an operationalized version of the 2025 consensus framework.
  • Outcomes analyzed included 28- and 90-day mortality, with assessments of case capture, overlap, mortality risk, sensitivity, specificity, and net reclassification improvement (NRI).

Main Results:

  • Substantial differences in ACLF prevalence were observed: A-TANGO identified higher percentages of ACLF cases (79.2% in TIH, 31.4% in CATCH-LIFE) compared to the consensus definition (42.3% in TIH, 5.8% in CATCH-LIFE).
  • A-TANGO captured most consensus ACLF cases and identified additional high-risk patients with significant mortality (28-day: 18.1%-26.9%; 90-day: 33.2%-37.9%).
  • A-TANGO demonstrated higher sensitivity for 28-day mortality, while the consensus criteria offered greater specificity. Reclassification analyses favored A-TANGO, showing improved discrimination and risk stratification within consensus non-ACLF groups.

Conclusions:

  • The A-TANGO and consensus frameworks identify distinct patient populations, with the consensus definition potentially under-recognizing high-risk individuals.
  • The outcome-calibrated A-TANGO framework appears more effective for ACLF diagnosis, clinical decision-making, risk stratification, and clinical trial design.
  • Further validation of A-TANGO is recommended to optimize ACLF management strategies.