CLIF-C ACLF
A prognostic score made for acute-on-chronic liver failure. ACLF-specific scores, such as those from the Chronic Liver Failure Consortium (CLIF-C), are preferred because they count both the liver and other failing organs.
AI Summary ICU and acute liver failure scores turn blood tests and bedside findings into numbers that help care teams judge how severe a sudden liver crisis is. CLIF-C ACLF, SOFA, and ALBI each do a different job. Acute liver failure affects people without chronic liver disease, while acute-on-chronic liver failure also involves other failing organs. Teams repeat checks, look for the cause, and weigh transplant. Scores support your care team's judgment; they never replace it.
Source: www.liverdirectory.com
ICU / Acute Liver Failure Scores
Medically Reviewed.
Acute liver failure (ALF) is a medical emergency in which the liver stops working quickly. In people with no known chronic liver disease, doctors see it as a clotting problem together with encephalopathy, a decline in brain function caused by the liver. ICU and acute liver failure scores turn test results and bedside findings into numbers the care team can track.
Some scores focus on the liver. Others count how many organs, such as the brain, kidneys, lungs, and circulation, are failing. No single score decides your care. Your team reads each score together with your exam, your labs, and how you respond to treatment.
This page explains what the scores in this group do, how ALF differs from acute-on-chronic liver failure, and how to prepare questions for the ICU and liver team.
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Sudden liver crisis basics
What Are ICU and Acute Liver Failure Scores?
ICU and acute liver failure scores are tools that help doctors judge how severe a sudden liver crisis is and how it may go. They draw on blood tests, such as bilirubin and INR (a clotting test), and on findings from the exam. Some also count organs outside the liver.
Two conditions matter most on this page:
- Acute liver failure (ALF): sudden, severe liver failure in a person without preexisting chronic liver disease. Clotting problems and encephalopathy mark it.
- Acute-on-chronic liver failure (ACLF): a sudden event in a person with chronic liver disease, with or without cirrhosis. It causes liver failure plus failure of at least one other organ.
A score describes one moment. For ACLF, doctors repeat their assessments of prognosis over time rather than relying on a single score. Scores support your care team's judgment. They do not replace it.
Scores in this group
Three Scores, Three Different Jobs
SOFA Score
The Sequential Organ Failure Assessment (SOFA) rates how well organs are working in intensive care. Its quick version, qSOFA, predicts hospital death in people with cirrhosis and infection better than older SIRS criteria. A positive qSOFA should prompt the team to consider ICU transfer.
ALBI Score
The albumin-bilirubin (ALBI) score uses two liver blood tests. Albumin is a protein the liver makes, and low levels can signal liver damage. Bilirubin is a yellow pigment that leaks into the blood when the liver is damaged.
Key numbers
ICU and Acute Liver Failure Scores at a Glance
Key points about how care teams judge sudden liver failure.
- INR above 1.5 is the usual sign of a clotting problem in ALF. Some doctors prefer prothrombin time (PT) compared with the lab's normal range, because INR is not fully standardized across labs.
- 30% to 50% of people with ACLF die within 28 days, depending on the definition used and the region.
- About 40% of ACLF cases have no clear trigger that doctors can find.
- Grade 3 or 4 hepatic encephalopathy is called brain failure in ACLF. A Glasgow Coma Scale score below 8 points to severe brain injury.
- Ammonia at or below 75 µM carries a low risk of raised pressure in the skull in ALF. Arterial ammonia above 200 µM predicts it.
- About 13% of acute liver failure cases in the United States come from drug-induced liver injury.
Know the difference
Acute Liver Failure vs. Acute-on-Chronic Liver Failure
The names sound alike, but the people affected and the scores used are different.
| Feature | Acute Liver Failure (ALF) | Acute-on-Chronic Liver Failure (ACLF) |
|---|---|---|
| Who it affects | People without preexisting chronic liver disease | People with chronic liver disease, with or without cirrhosis |
| Main features | Clotting problems (INR above 1.5) and encephalopathy | High bilirubin and INR plus failure of at least one other organ |
| Organs counted | Liver and brain are the focus | Brain, circulation, lungs, or kidneys |
| Scores used | Clinical criteria, labs, and ICU monitoring | ACLF-specific scores such as CLIF-C, NACSELD, or AARC |
| Can MELD alone guide care? | Not the main tool for prognosis | No. MELD and MELD-Na do not count other organ failures |
Acute decompensation of cirrhosis, such as a flare of fluid buildup, is a third category. It does not always involve multiple failing organs.
ICU monitoring and care
How Scores and Monitoring Are Used in Intensive Care
Scores are one part of close watching. Your team repeats checks often because ALF and ACLF can change within hours.
Watching the Brain
In ALF, the team checks for signs of worsening hepatic encephalopathy at least every 2 hours. In ACLF, doctors protect the airway and consider ICU care for severe encephalopathy. Learn more about [hepatic encephalopathy](/liver-diseases/hepatic-encephalopathy) and its grades.
Checking for Other Organ Failure
ACLF scores count the brain, circulation, lungs, and kidneys because these failures often decide the outcome. In ALF, continuous kidney replacement therapy is preferred over intermittent dialysis when kidney support is needed, to avoid swings that could raise pressure in the skull.
Looking for the Cause
A cause can change treatment. Very high aminotransferases with low bilirubin suggest acetaminophen (paracetamol) overdose. In that setting, N-acetylcysteine (NAC) can protect liver cells when given promptly. Drug-induced injury, viral hepatitis, and autoimmune hepatitis are other causes.
Deciding About Transplant
Scores help the team decide how urgent a transplant evaluation is. For ALF, irretrievable brain injury is the only absolute contraindication to emergency transplant. For ACLF, early recognition, organ support, and transplant evaluation are key. See the [liver transplant](/liver-diseases/liver-transplant) overview.
Support Your Diet Alongside Your Care
Amsety Bars were designed for people with liver conditions by liver health experts. They offer a convenient way to add energy and nutrients to a liver-friendly diet. Ask your provider what fits your needs.
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Prepare for ICU conversations
Questions to Ask the ICU and Liver Team
ICU stays move fast and can feel overwhelming. These questions help you follow what the numbers mean.
- Ask which scores the team is using and what each one measures.
- Ask how often the scores are repeated and what change would be good news or a concern.
- Ask whether the condition is acute liver failure or acute-on-chronic liver failure, and what the team thinks caused it.
- Ask which organs besides the liver are being supported or watched.
- Ask whether a transplant evaluation is under way and who your contact is at the transplant center.
- Ask what you can do as family, such as sharing a list of medicines, supplements, and alcohol use, since this can help the team find the cause.
Ask a nurse or the care team to write down the names of the scores they use so you can look them up later.
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Common questions
Answers to Common ICU / Acute Liver Failure Scores Questions
What Is the Difference Between ALF and ACLF?
ALF happens in people without known chronic liver disease, while ACLF happens in people who already have chronic liver disease. ACLF also requires failure of at least one other organ, such as the brain, kidneys, lungs, or circulation.
Can One Score Predict Whether Someone Will Recover?
No single score tells the whole story. In ACLF, doctors repeat prognosis checks over time instead of relying on one number. Your team also considers your exam, the cause of the illness, and how you respond to treatment.
Why Is MELD Not Enough for ACLF?
MELD and MELD-Na mainly reflect the liver itself and do not count failing organs outside the liver. In ACLF those failures often decide the outcome. ACLF-specific scores such as CLIF-C are therefore preferred. You can read about [MELD](/liver-tests/medical-scores/liver-severity-cirrhosis-scores/meld-score) on its own page.
When Is Intensive Care Needed for Liver Failure?
Doctors consider ICU care when encephalopathy becomes severe (grade 3 or 4) or when organs such as the kidneys, lungs, or circulation begin to fail. A positive qSOFA score in a person with cirrhosis and infection should prompt consideration of ICU transfer. Your team makes this call based on your full situation.
Can Liver Failure Be Treated if It Is Caught Early?
Yes, when the cause is acetaminophen (paracetamol) overdose, N-acetylcysteine (NAC) can protect liver cells if given promptly. In other causes of ALF, NAC has not been shown to improve survival overall. It does help adults with mild encephalopathy, and its use is usually limited to 5 days. Your doctors decide if it fits your case.
Medical disclaimer: LiverDirectory provides educational information and a directory of providers. It does not provide medical advice, diagnosis, or treatment. Always consult a licensed physician regarding any medical condition.