CLIF-SOFA and Urine Neutrophil Gelatinase-Associated Lipocalin Score for the Diagnosis of Acute-on-Chronic Liver Failure and as a Prognostic Tool for Mortality Prediction
Tongluk Teerasarntipan MD1, Khajohn Tiranathanagul MD, MSc2,3, Kessarin Thanapirom MD, MSc1,3, Roongruedee Chaiteerakij MD, PhD1,3, Piyawat Komolmit MD, PhD1,3, Pisit Tangkijvanich MD3,4, Sombat Treeprasertsuk MD, PhD1,3
Affiliation : 1 Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 2 Division of Nephrology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 3 King Chulalongkorn Memorial Hospital, Thai Red Cross, Bangkok, Thailand 4 Center of Excellence in Hepatitis and Liver Cancer, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Objective : To validate the chronic liver failure-sequential organ failure assessment [CLIF-SOFA] tool for the diagnosis of acute-on-
chronic liver failure [ACLF] in hospitalized Thai patients with cirrhosis and to evaluate the clinical signi(cid:976)icance of urine neutrophil
gelatinase-associated lipocalin [uNGAL] in combination with the CLIF-SOFA score to predict ACLF mortality.
Materials and Methods : Seventy-seven patients were enrolled. The authors generated new ACLF diagnostic criteria by combining
the uNGAL level with the original renal failure criteria from the CLIF-SOFA score [CLIF/NGAL score]. The primary endpoint was
the 30-day mortality rate [MR].
Results : ACLF patients, according to the original CLIF-SOFA score, had a 43.7% MR in comparison to the non-ACLF patients, who
had a 13.3% MR. The calculated odds ratio [OR] was 3.28, with an area under the ROC [AUROC] of 0.750 (95% CI 0.62 to 0.88, p =
0.001). The CLIF/NGAL score demonstrated better prognostic prediction ability. The MR was 38.6%, with an OR of 4.03 (95% CI
1.29 to 12.61) and an AUROC of 0.772 (95% CI 0.65 to 0.90, p<0.001).
Conclusion : The CLIF-SOFA score is valid for ACLF diagnosis among Thai patients. Moreover, the authors new proposed criteria,
the CLIF/NGAL score, demonstrated better potential than the original criteria for ACLF mortality prediction.
Keywords : Renal failure, NGAL, Acute-on-chronic liver failure, Cirrhosis, Mortality
