Performance of the China-CLIF framework in acute-on-chronic liver failure: a multicohort study across all aetiologies

作者：Jinjin Luo, Meiqian Hu, Tingting Feng, Liyuan Zhang, Yan Huang, Yuxian Huang, Feng Ye, Jiang Li, Jiang Li, Ferrán Aguilar, Cristina Sánchez-Garrido, Eva Usón-Raposo, Bing Zhu, Qian Zhou, Xi Liang, Jiaqi Li, Jiaqi Li, Peng Li, Jiaojiao Xin, Dongyan Shi, Jianming Zheng, Huafen Zhang, Baoju Wang, Wei Qiang, Heng Yao, Xingping Zhou, Jiaxian Chen, Wen Hu, Bingqi Li, Shiwen Ma, Xiao Wu, Xiao Li, Yuheng Kong, Feiyang Sun, Xi Chen, Tianzhou Wu, Lingling Yang, Suwan Sun, Beibei Guo, Lulu He, Jinjun Chen, Shaojie Xin, Xue Li, Huazhong Chen, Paolo Angeli, Rajiv Jalan, Bingliang Lin, Yu Chen, Shaoli You, Xin Chen, Alberto Queiróz Farias, Jonel Trebicka, Jing Jiang, Richard Moreau, Jun Li, Jun Li, The CANONIC, PREDICT, ACLARA Study Group · 发表于：Gut · 年份：2025 · DOI：10.1136/gutjnl-2025-335651 · 被引用次数：6 · 研究领域：Liver Disease and Transplantation、Hepatitis C virus research、Clinical Nutrition and Gastroenterology

BACKGROUND: Acute-on-chronic liver failure (ACLF) of various aetiologies is a complex syndrome with high short-term mortality and significant global burden. OBJECTIVE: To explore easily applicable diagnostic criteria and an accurate prognostic score for ACLF. DESIGN: Clinical data from 5288 patients (after exclusions from 7388 screened) with acute deterioration of chronic liver disease across various aetiologies were used to evaluate the performance of European Chronic Liver Failure (CLIF) and Chinese Group on the Study of Severe Hepatitis B (COSSH) criteria. Three non-Asian cohorts were performed to validate the results. RESULTS: CLIF criteria categorised 844 patients as ACLF (28-day/90-day liver transplantation (LT)-free mortality: 40.7%/57.0%; 321 with non-hepatitis B virus (HBV) aetiology, 523 with HBV aetiology), while COSSH criteria categorised 2038 patients as ACLF (mortality: 27.3%/41.0%; 602 with non-HBV aetiology, 1436 with HBV aetiology). COSSH criteria identified 22.6% (1194/5288) more patients (mortality: 19.1%/31.4%) compared with CLIF criteria, including 14.2% non-HBV patients (mortality: 15.9%/33.3%). COSSH criteria produced a more reasonable epidemiological pyramid-like distribution across severity grades (grades 1-3: 63.4%/27.5%/9.1% vs CLIF's grades 1-3: 25.8%/56.3%/17.9%). COSSH-ACLF II score showed the highest predictive values for 28-day/90-day LT-free mortality in both cirrhotic and all ACLF patients with various aetiologies, outperforming the CLIF-C AC...