CLIF-C ACLF estimates short-term mortality in adults with acute-on-chronic liver failure (ACLF) as defined by the EASL–CLIF consortium. It combines the CLIF-C Organ Failure (OF) score, age and white cell count into a 0–100 scale.

The score was derived from the CANONIC study of 1,349 adults non-electively admitted with acute decompensation of cirrhosis across European centres. Of these, 275 patients with ACLF formed the derivation cohort and 225 patients with ACLF an external validation cohort. CLIF-C ACLF showed better discrimination than Child–Pugh, MELD and MELD-Na for 28-, 90-, 180- and 365-day mortality, with prediction error reduced by around 20–28% at each time point.

CLIF-C ACLF score	Derivation cohort (28-day mortality)	External validation (28-day mortality)	Comment
≤40	High negative predictive value (~90%) and sensitivity (~97%)	Negative predictive value ~77%, sensitivity ~97%	Identifies a lower-risk group within an overall high-risk ACLF population
≈51	Sensitivity ~64%, specificity ~75%	Lower positive and negative predictive values than 40/60 cut-offs	Balances sensitivity and specificity but less commonly used clinically
≥60	Positive predictive value ~82%, specificity ~94%	Positive predictive value ~91%, specificity ~93%	Defines a high-risk band for short-term mortality

Subsequent ICU cohorts suggest that when CLIF-C ACLF remains ≥70 despite 48 hours of full intensive care support, 28-day mortality without liver transplantation approaches 100%, with about 90% mortality by 90 days. This very high score should inform shared decisions about escalation, transplantation and goals of care rather than act as a rigid futility threshold.

Use in adults with cirrhosis and ACLF meeting EASL–CLIF criteria. It is not validated for uncomplicated decompensated cirrhosis, where CLIF-C AD or MELD-based scores are often used instead, non-cirrhotic chronic liver disease or paediatric patients.
EASL ACLF guidance recommends sequential use of CLIF-C OF and CLIF-C ACLF during admission (baseline, 48 hours, 3–7 days and 8–15 days) to track trajectory and guide transplant referral and palliative care discussions.
The score estimates mortality risk, not transplant benefit. Very high scores may still be compatible with meaningful benefit from urgent liver transplantation in suitable candidates.

CLIF-C ACLF Score for Acute-on-Chronic Liver Failure