CLIF-C ACLF (Acute-on-Chronic Liver Failure)

• The score can be recalculated after 48 hours as a marker of response to treatment.

• If there is no acute-on-chronic liver failure (ACLF grade 0), the CLIF-C AD (acute decompensation) score can be used instead to predict mortality.

• There is no single specific treatment for ACLF. Management is focused on organ support and treatment of reversible causes. 

• Remember that sepsis can often be difficult to spot in patients with cirrhosis. Infection was identified as a potential precipitating factor in around a third of patients in the derivation study.

• Take blood, urine, and ascitic fluid samples to identify possible infection. Consider empiric use of antibiotics.

Discuss with the patient and with critical care colleagues as appropriate regarding options for escalation of care.