CLIF-AKI score predicts KDIGO stage 3 acute kidney injury in intensive care unit patients with acute-on-chronic liver failure

doi:10.3748/wjg.122612

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World Journal of Gastroenterology

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1007-9327

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Gastroenterol. Dec 28, 2026; 32(48): 122612
Published online Dec 28, 2026. doi: 10.3748/wjg.122612

CLIF-AKI score predicts KDIGO stage 3 acute kidney injury in intensive care unit patients with acute-on-chronic liver failure

Nan Wang, You-Wen Tan, Peng-Fei Zhang, Xing-Bei Zhou, Li Zhu

Nan Wang, Department of Geriatrics, Zhenjiang First People’s Hospital, Affiliated People’s Hospital of Jiangsu University, Zhenjiang 212002, Jiangsu Province, China

You-Wen Tan, Peng-Fei Zhang, Xing-Bei Zhou, Li Zhu, Department of Hepatology, Zhenjiang Third People’s Hospital, Affiliated Zhenjiang Third Hospital of Jiangsu University, Zhenjiang 212009, Jiangsu Province, China

Co-first authors: Nan Wang and You-Wen Tan.

Author contributions: Wang N and Tan YW contributed to conceive and design the study, and data validation as co-first authors; Wang N, Tan YW, and Zhou XB collected the data; Zhu L and Tan YW verified data completeness and validated the analyses; Zhang PF performed the statistical analyses; Wang N drafted the manuscript; Tan YW, Zhang PF, and Wang N interpreted the results and critically revised the manuscript. All authors read and approved the final manuscript.

AI contribution statement: In accordance with the journal’s requirements, we would like to disclose that AI tools were used only for language editing and proofreading of parts of the manuscript. Specifically, the use of AI was limited to grammar correction, spelling correction, and improvement of readability and clarity. AI tools were not used to generate scientific content, original data, figures, tables, references, raw data analysis, statistical analyses, or scientific conclusions.

Supported by Zhenjiang Science and Technology Plan for Social Development, No. SH2024074.

Institutional review board statement: The study was approved by the Ethics Committee of Zhenjiang Third People’s Hospital, No. AF01-SOP-G-14-04.2.

Informed consent statement: For the Medical Information Mart for Intensive Care IV cohort, patient information was de-identified and included in a publicly available database in accordance with the database governance and ethical approval procedures. For the Zhenjiang cohort, the requirement for informed consent was waived by the Ethics Committee of Zhenjiang Third People’s Hospital because of the retrospective nature of this study.

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: The data supporting the findings of this study are available from the corresponding author upon reasonable request.

Corresponding author: Peng-Fei Zhang, MSc, Attending Physician, Department of Hepatology, Zhenjiang Third People’s Hospital, Affiliated Zhenjiang Third Hospital of Jiangsu University, No. 300 Daijiamen Road, Zhenjiang 212009, Jiangsu Province, China. jsdxzpf@163.com

Received: April 24, 2026
Revised: July 7, 2026
Accepted: July 31, 2026
Published online: December 28, 2026
Processing time: 193 Days and 19 Hours

Abstract

BACKGROUND

Reliable tools for the early detection of stage 3 acute kidney injury (AKI) in patients with acute-on-chronic liver failure (ACLF) are limited. We developed a scoring system to predict stage 3 AKI within 14 days of intensive care unit (ICU) admission.

AIM

To externally validate the predictive score for stage 3 AKI in patients with ACLF within 14 days of ICU admission.

METHODS

Patients with cirrhosis admitted to the ICU who met the diagnostic criteria for ACLF were included. Two independent cohorts were established for the model derivation (1314 patients from the Medical Information Mart for Intensive Care IV database) and the external validation (223 patients from Zhenjiang). The primary outcome was stage 3 AKI occurring within 14 days of ICU admission. Predictors were selected using least absolute shrinkage and selection operator regression and were subsequently entered into a multivariable logistic regression model.

RESULTS

Stage 3 AKI occurred in 34% of the derivation cohort and 30% of the validation cohort. The chronic liver failure organ failure (CLIF)-AKI score was developed using eight variables: Mechanical ventilation, vasopressor use, serum albumin, mean arterial pressure, white blood cell count, blood urea nitrogen, model for end-stage liver disease (MELD) score, and body mass index. The score demonstrated good discrimination [area under the receiver operating characteristic curve: 0.79 (95% confidence interval: 0.76-0.82) in the derivation cohort and 0.86 (95% confidence interval: 0.81-0.91) in the validation cohort], and showed acceptable calibration in both. The score stratified patients into four risk categories. In the validation cohort, CLIF-AKI score outperformed PIRO, chronic liver failure consortium ACLF, Child-Turcotte-Pugh, MELD, and MELD-sodium in predicting stage 3 AKI (all P < 0.05).

CONCLUSION

The CLIF-AKI score enables the early identification of ICU patients with ACLF who are at high risk of developing Kidney Disease: Improving Global Outcomes stage 3 AKI within 14 days of admission.

Keywords: Acute kidney injury; Acute-on-chronic liver failure; Predictive score; Risk stratification; Intensive care unit

Core Tip: Patients with acute-on-chronic liver failure admitted to the intensive care unit are at high risk of developing stage 3 acute kidney injury (AKI); however, reliable tools for early prediction remain limited. We developed and externally validated the chronic liver failure organ failure-AKI score to predict stage 3 AKI in patients with acute-on-chronic liver failure. The score demonstrated good discrimination and clinical utility, and outperformed the PIRO model and existing prognostic scores in the external validation cohort. We also developed a point-based scoring system and an online calculator to facilitate its implementation in clinical practice.