Acute-on-Chronic Liver Failure Score

CLIF-C ACLF Calculator

Liver disease · Prognosis

CLIF-C ACLF Calculator

Predicts short-term mortality risk in adults with established acute-on-chronic liver failure (ACLF).

Use only in established ACLF. This tool is intended for adults with acute decompensation of cirrhosis who meet ACLF criteria. It is not for acute liver failure. If ACLF is absent, consider the CLIF-C AD score instead.

Patient information

Age and inflammatory response

Age *

years

Adult patients only

WBC count *

×10⁹/L

White blood cell count must be greater than 0

CLIF-C Organ Failure assessment

Six organ systems, each scored from 1 to 3

Liver

Bilirubin *

mg/dL

Score: <6 = 1; 6–<12 = 2; ≥12 = 3

Kidney

Creatinine *

mg/dL

Score: <2 = 1; 2–<3.5 = 2; ≥3.5 = 3

Renal replacement therapyAutomatically scores kidney as 3

Brain

West Haven grade for hepatic encephalopathy *

Intubated due to hepatic encephalopathyUse only when intubation is for encephalopathy and not respiratory failure; scores brain as 3

Coagulation

INR *

ratio

Score: <2.0 = 1; 2.0–<2.5 = 2; ≥2.5 = 3

Circulatory

Mean arterial pressure (MAP) *

mmHg

Score: ≥70 = 1; <70 = 2

Receiving vasopressors for circulatory failureAny MAP with vasopressors scores circulation as 3

Respiratory

Information available *

PaO₂/FiO₂ ratio *

ratio

Score: >300 = 1; >200–300 = 2; ≤200 = 3

Intubated for respiratory failureAutomatically scores respiratory system as 3

Formula and interpretation

CLIF-C ACLF = 10 × [0.33 × CLIF-C OF + 0.04 × age + 0.63 × ln(WBC) − 2]

The CLIF-C OF score is the sum of the six organ-system subscores. The displayed whole-number result is rounded to the nearest integer and constrained to the published 0–100 scale.

Mortality statements are broad, cohort-derived risk bands rather than an individualized probability. Recalculate sequentially when clinically appropriate; a reassessment after 48 hours may better reflect response to treatment.

Clinical cautions

Do not use the result alone to make escalation, transplant, or end-of-life decisions.
Use the most clinically appropriate contemporaneous measurements and interpret alongside the complete clinical picture.
A score ≥70 after 48 hours of full intensive care support was associated with extremely poor outcomes in one external cohort; this must not be treated as a universal futility rule.

Evidence sources

Jalan R, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. Journal of Hepatology. 2014;61(5):1038–1047.

European Foundation for the Study of Chronic Liver Failure. CLIF-C OF and CLIF-C ACLF score calculators.

Engelmann C, et al. Validation of CLIF-C ACLF score to define a threshold for futility of intensive care support. Critical Care. 2018;22:254.

Patient information

CLIF-C Organ Failure assessment

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