Interguideline differences in ACLF definition

CharacteristicsAPASLEASL-CLIFNACSELD
DefinitionAcute jaundice and coagulopathy, followed by ascites ± HE within 4 weeksSpecified criteria using CLIF-OF score for OF, 28-day mortality rate > 15%≥ 2 extrahepatic OF (circulation, kidney, cerebral, respiratory)
Organ failureAARC scoreCLIF-C OF scoreMELD score
LiverT. Bil ≥ 5 mg/dL + INR ≥ 1.5T. Bil ≥ 12 mg/dL-
KidneyAKI Network criteriaCr ≥ 2 or RRTRRT
CerebralHE 3–4HE 3–4HE 3–4
Coagulopathy-INR ≥ 2.5-
Circulatory-Need to use of vasopressor (terlipressin and/or catecholamines)Shock (MAP < 60 mmHg or > 40 mmHg systolic BP reduction from baseline)
Respiratory-PaO2/FiO2 ≤ 200 or sPO2/FiO2 ≤ 214 or need for mechanical ventilation (≤ 300 for ALI or ≤ 200 for ARDS)Need for mechanical ventilation
Inclusion criteriaUndiagnosed or diagnosed chronic liver disease, including cirrhosisCirrhosis ± prior decompensationInpatient cirrhosis (± prior decompensation) with infection at or during admission
Exclusion criteriaPrior decompansation
Bacterial infection
GI bleeding
HCC
HCC with beyond Milan criteria
Receiving immunosuppressive treatment
HIV
Severe chronic extrahepatic disease
Outpatients with infection
Cirrhosis without infection
HIV
Prior organ transplantation
Disseminated malignancies
Time frame4 weeks4–12 weeksNot defined
Major organ failureHepaticHepatic + extrahepaticExtrahepatic
Time of diagnosisEarlyModerateToo late

AARC: APASL-ACLF research consortium; ACLF: acute-on-chronic liver failure; AKI: acute kidney injury; ALI: acute lung injury; APASL: Asian Pacific Association for the Study of the Liver; ARDS: adult respiratory distress syndrome; Cr: creatinine; EASL-CLIF: European Association for the Study of the Liver-Chronic Liver Failure; FiO2: fraction of inspired oxygen; GI: gastrointestinal; HCC: hepatocelluler carcinoma; HE: hepatic encephalopathy (West-Haven criteria); HIV: human immunodeficiency virus; INR: international normalized ratio; MAP: mean arterial pressure; MELD: Model of the End Liver Disease; NACSELD: North American Consortium for the Study of End-Stage Liver Disease; OF: organ failure; PaO2: partial pressure of arterial oxygen; RRT: renal replacement therapy; BP: blood pressure; sPO2: pulse oximetric saturation; T.Bil: total bilirubin