1. DR. MOHD YASIR
JR MEDICINE
GUIDE-Dr. PROF. A.C. GUPTA
MD MEDICINE
COMPARISON OF CHRONIC LIVER FAILURE
CONSORTIUM ACUTE ON CHRONIC LIVER
FAILURE(CLIF-C ACLF) SCORE AND MELD
SODIUM(MELD-Na)SCORE IN PREDICTING
MORTALITY IN PATIENTS WITH ACUTE-ON-
CHRONIC LIVER FAILURE
2. INTRODUCTION
• Acute on chronic liver failure (ACLF) is a clinical syndrome of
sudden hepatic decompensation in patients with pre- existing
chronic liver disease
• It may be associated with one or more extrahepatic organ failures
having increased mortality.
• Regardless of the etiology of chronic liver injury, the initial
uncomplicated chronic liver disease eventually leads to cirrhosis
and, later, the decompensation of liver function with ascites,
jaundice, portal hypertension with variceal bleeding, and hepatic
encephalopathy.
3. • Type-A ACLF is an acute worsening of liver function in a
patient with chronic liver disease.
• Type-B ACLF is when this acute decompensation occurs in
patients with cirrhosis.
• Type-C ACLF is acute worsening of liver function in
decompensated cirrhotics.
4. • Liver - Bilirubin level of >12 mg/dL
• Kidney - Creatinine level of >2.0 mg/dL or renal replacement
• Brain- West-Haven hepatic encephalopathy grade 3-4
• Coagulation - INR >2.5
• Circulation - Use of vasopressor (terlipressin and/or catecholamines)
• Respiration- Pa02/Fi02 of ≤200 or Spo2/FiO2 ≤214 or need for mechanical
ventilation
European Association for the Study
of Liver (EASL)- definition
5. OBJECTIVES
To compare CLIF-C ACLF Score And MELD-Na Score In
Predicting Mortality In Patients With Acute-On-Chronic Liver
Failure.
6. METHODOLOGY
TYPE OF STUDY- PROSPECTIVE OBSERVATIONAL
STUDY
INCLUSION CRITERIA-
Age > 18 years.
Men and Women having acute on chronic liver failure.
Subjects who are willing to participate in the study.
7. Exclusion criteria
HIV positive patients
Pregnant and lactating females
Patients having HCC.
Patients having secondary liver metastasis.
8. • Complete blood count (CBC)- Complete Hb (g%), TLC , DLC , Platelet
Counts
• Liver Function Test- S.Bilirubin(Total/Direct/Indirect),
S.Proteins/S.Albumin, SGOT/SGPT
• Kidney Function Test- S. Urea , S. Creatinine
• Serum electrolytes- S. Na+, S. K+
• PT/INR
• ABG- PaO2
INVESTIGATIONS
9. Data will be compiled and analyzed using SPSS 22.0
Categorical variables will be analyzed using percentages and
Pearson’s chi square test.
Quantitative variables in the two groups will be analyzed using
mean , standard deviation and paired t-test.
p value less than 0.05 will be considered significant.
STATISTICAL ANALYSIS
