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

IF 25.8 1区医学 Q1 GASTROENTEROLOGY & HEPATOLOGY

Gut Pub Date : 2025-07-25 DOI:10.1136/gutjnl-2025-335651

Jinjin Luo, Meiqian Hu, Tingting Feng, Liyuan Zhang, Yan Huang, Yuxian Huang, Feng Ye, Jiang Li, Ferran Aguilar, Cristina Sánchez-Garrido, Eva Usón-Raposo, Bing Zhu, Qian Zhou, Xi Liang, 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 Queiroz Farias, Jonel Trebicka, Jing Jiang, Richard Moreau, Jun Li, The CANONIC, PREDICT, ACLARA Study Group

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引用次数: 0

Abstract

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 ACLF and other scores. The comparable performance of China-CLIFs (renamed from COSSH-ACLFs) was validated in three non-Asian cohorts. Conclusions This study evaluated the broader applicability of the China-CLIF framework across diverse aetiologies and varying severity levels of ACLF. These findings may provide a valuable foundation for harmonising ACLF diagnostic and prognostic system. All data relevant to the study are included in the article or uploaded as supplementary information.

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中国- clif框架在急性-慢性肝衰竭中的表现：一项涵盖所有病因的多队列研究

各种病因的急性慢性肝衰竭（ACLF）是一种复杂的综合征，具有高短期死亡率和显著的全球负担。目的探讨易于应用的ACLF诊断标准和准确的预后评分。设计5288例不同病因的慢性肝病急性恶化患者（从7388例筛选中排除后）的临床数据用于评估欧洲慢性肝衰竭（CLIF）和中国重型乙型肝炎研究组（COSSH）标准的表现。进行了三个非亚洲队列来验证结果。结果CLIF标准将844例患者归为ACLF(无肝移植（LT） 28天/90天死亡率：40.7%/57.0%；321例为非乙型肝炎病毒（HBV）病因，523例为HBV病因)，而COSSH标准将2038例患者分类为ACLF(死亡率：27.3%/41.0%；602例为非HBV病因，1436例为HBV病因)。与CLIF标准相比，COSSH标准确定的患者（死亡率：19.1%/31.4%）增加22.6%(1194/5288)，其中非hbv患者（死亡率：15.9%/33.3%）增加14.2%。cosh标准在严重程度等级之间产生了更合理的流行病学金字塔状分布（1-3级：63.4%/27.5%/9.1%，而CLIF的1-3级：25.8%/56.3%/17.9%）。cosh -ACLF II评分对肝硬化和各种病因的所有ACLF患者的28天/90天无lt死亡率的预测价值最高，优于ccliff - c ACLF和其他评分。在三个非亚洲队列中验证了china - cliffs（从COSSH-ACLFs重命名）的可比性能。本研究评估了中国- clif框架在不同病因和不同严重程度ACLF中的广泛适用性。这些发现可能为协调ACLF诊断和预后系统提供有价值的基础。所有与研究相关的数据都包含在文章中或作为补充信息上传。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Gut 医学-胃肠肝病学

CiteScore

45.70

自引率

2.40%

发文量

284

审稿时长

1.5 months

期刊介绍： Gut is a renowned international journal specializing in gastroenterology and hepatology, known for its high-quality clinical research covering the alimentary tract, liver, biliary tree, and pancreas. It offers authoritative and current coverage across all aspects of gastroenterology and hepatology, featuring articles on emerging disease mechanisms and innovative diagnostic and therapeutic approaches authored by leading experts. As the flagship journal of BMJ's gastroenterology portfolio, Gut is accompanied by two companion journals: Frontline Gastroenterology, focusing on education and practice-oriented papers, and BMJ Open Gastroenterology for open access original research.