Modified EASL-CLIF criteria that is easier to use and perform better to prognosticate acute-on-chronic liver failure

Table 1 The definitions of modified the European Association for the Study of the Liver-Chronic Liver Failure Consortium organ failures and grades

Definition of mEACLF organ failures
Liver	Bilirubin ≥ 12 mg/dL
Coagulation	INR ≥ 2.0
Brain	Hepatic encephalopathy grade 3-4
Kidney	Serum creatinine ≥ 2.35 mg/dL or renal replacement
Heart	On vasopressors
Respiration	On mechanical ventilation
Definition of mEACLF grades
Grade 1	Any one organ failure
Grade 2	Any 2 organ failures
Grade 3	Any 3 or more organ failures

mEACLF: Modified the European Association for the Study of the Liver-Chronic Liver Failure Consortium; INR: International normalized ratio.

Table 2 Characteristics of patients with the European Association for the Study of the Liver-Chronic Liver Failure Consortium and modified the European Association for the Study of the Liver-Chronic Liver Failure Consortium organ failures

Variable	Response	All (n = 29618)	EASL-CLIF (n = 14044)	mEACLF (n = 15574)	P value
Age	mean ± SD	52.9 ± 11.6	52.9 ± 11.7	52.9 ± 11.8	0.46
Gender, n (%)	Female	11803 (40)	5601 (40)	6202 (40)	0.92
Race, n (%)	White	20059 (68)	9484 (68)	10575 (68)	0.95
	Black	2530 (9)	1215 (9)	1315 (8)
	Hispanic	5242 (18)	2496 (18)	2746 (18)
	Asian	1129 (4)	540 (4)	589 (4)
	Others	658 (2)	309 (2)	349 (2)
Etiology, n (%)	HCV	3661 (12)	1730 (12)	1931 (12)	0.87
	Alcohol	12537 (42)	5909 (42)	6628 (43)
	HCV + Alcohol	353 (1)	165 (1)	188 (1)
	Cryptogenic	1507 (5)	712 (5)	795 (5)
	Others	11560 (39)	5528 (39)	6032 (39)
Bilirubin	mean ± SD	13.8 ± 12.5	14.1 ± 12.7	13.4 ± 12.3	0.001
Creatinine	mean ± SD	2.11 ± 1.79	2.19 ± 1.81	2.03 ± 1.77	< 0.001
INR	mean ± SD	2.30 ± 1.12	2.29 ± 1.15	2.30 ± 1.08	< 0.001
Encephalopathy, n (%)	Grade 3-4	7088 (24)	3544 (25)	3544 (23)	< 0.001
Respiration, n (%)	Yes	1598 (5)	799 (6)	799 (5)	0.03
Circulatory, n (%)	Yes	2684 (9)	1342 (10)	1342 (9)	0.005
MELD-Na	mean ± SD	29.9 ± 8.1	30.2 ± 8.2	29.7 ± 8.0	< 0.001
Albumin	mean ± SD	3.10 ± 0.74	3.12 ± 0.74	3.08 ± 0.74	< 0.001
Ascites, n (%)	Moderate	13357 (45)	6456 (46)	6901 (44)	0.02

INR: International normalized ratio; EASL-CLIF: European Association for the Study of the Liver-Chronic Liver Failure Consortium; mEACLF: Modified EASL-CLIF; HCV: Hepatitis C virus; MELD: Model for End-stage Liver Disease.

Table 3 The distribution of patients by the number of organ failure by the European Association for the Study of the Liver-Chronic Liver Failure Consortium and modified the European Association for the Study of the Liver-Chronic Liver Failure Consortium criteria

Number of OF by EASL-CLIF	Number of OF by mEACLF criteria
	0	1	2	3	4	5	6	Total
0	24227	2086	0	0	0	0	0	26313
1	556	5748	1395	0	0	0	0	7699
2	0	229	2875	653	0	0	0	3757
3	0	0	152	1193	215	0	0	1560
4	0	0	0	52	458	96	0	606
5	0	0	0	0	10	238	63	311
6	0	0	0	0	0	8	103	111
Total	24783	8063	4422	1898	683	342	166	40357

EASL-CLIF: European Association for the Study of the Liver-Chronic Liver Failure Consortium; mEACLF: Modified European Association for the Study of the Liver; OF: Organ failures.

Table 4 The distribution of patients by the European Association for the Study of the Liver-Chronic Liver Failure Consortium and modified European Association for the Study of the Liver-Chronic Liver Failure Consortium grades of the acute-on-chronic liver failure and their 30-d all-cause mortality

EASL-CLIF grade	Number of patients mEACLF Grade (all-cause mortality%)
	0	1	2	3	Total
0	24227 (1.2)	5114 (3.3)	1372 (10.2)	0	30713 (2.0)
1	556 (4.1)	2720 (6.5)	23 (10.2)	0	3299 (6.1)
2	0	229 (13.1)	2875 (11.8)	653 (15.0)	3757 (12.5)
3	0	0	152 (21.7)	2436 (24.5)	2588 (24.4)
Total	24783 (1.3)	8063 (4.7)	4422 (11.7)	3089 (22.5)	40357 (4.7)

EASL-CLIF: European Association for the Study of the Liver-Chronic Liver Failure Consortium; ACLF: Acute-on-chronic liver failure.