Modified EASL-CLIF criteria that is easier to use and perform better to prognosticate acute-on-chronic liver failure

BACKGROUND We have recently shown that the European Association for the Study of the LiverChronic Liver Failure Consortium(EASL-CLIF) criteria showed a better sensitivity to detect acute-on-chronic liver failure(ACLF) with a better prognostic capability than the North American Consortium for the Study of End-Stage Liver Disease criteria.AIM To simplify EASL-CLIF criteria for ease of use without sacrificing its sensitivity and prognostic capability.METHODS Using the United Network for Organ Sharing data(January 11, 2016, to August 31, 2020), we modified EASL-CLIF(m EACLF) criteria; the modified m EACLF criteria included six organ failures(OF) as in the original EASL-CLIF, but renal failure was defined as creatinine ≥ 2.35 mg/d L and coagulation failure was defined as international normalized ratio(INR) ≥ 2.0. The m EACLF grades(0, 1, 2, and ≥ 3) directly reflected the number of OF.RESULTS Of the 40357 patients, 14044 had one or more OF, and 9644 had ACLF grades 1-3 by EASL-CLIF criteria. By the m EACLF criteria, 15574 patients had one or more OF. The area under the receiver operating characteristic(AUROC) for 30-d allcause mortality by OF was 0.842(95%CI: 0.831-0.853) for m EACLF and 0.835(95%CI: 0.824-0.846) for EASL-CLIF(P = 0.006), and AUROC for 30-d transplantfree mortality by OF was 0.859(95%CI: 0.849-0.869) for m EACLF and 0.851(95%CI: 0.840-0.861) for EASL-CLIF(P = 0.001). The AUROC of 30-d all-cause mortality by ACLF grades was 0.842(95%CI: 0.831-0.853) for m EACLF and 0.793(95%CI: 0.781-0.806) for EASL-CLIF(P < 0.0001). The AUROC of 30-d transplant-free mortality by ACLF was 0.859(95%CI: 0.848-0.869) for m EACLF and 0.805(95%CI: 0.793-0.817) for EASL-CLIF(P < 0.0001).CONCLUSION Our study showed that EASL-CLIF criteria for ACLF grades could be simplified for ease of use without losing its prognostication capability and sensitivity.