Letter to the Editor: Serum alpha-fetoprotein dynamics in liver failure - prognostic implications and clinical insights

Table 1 Comparison of existing prognostic models in acute-on-chronic liver failure and alpha-fetoprotein dynamics

Prognostic tool	Main inputs	Strengths	Limitations	Reflects regenerative potential
CTP score	Hepatic encephalopathy, ascites, total bilirubin, albumin, prothrombin time	Simple	Subjective, grading stenosis and lack of corresponding weights for each indicator	Low
MELD score	Bilirubin, INR, creatinine	Widely validated; useful for transplant allocation; objective indicators; reliable indicators; easy to obtain	Some clinical factors are not taken into account	Low
SOFA	Six organ systems: Respiration; coagulation; liver; cardiovascular; renal, CNS	Simple; continuous monitoring; widely used in ICU	Primarily reflects organ injury, not liver regeneration	Low
COSSH-ACLF score	Bilirubin, INR, creatinine, neutrophil count, organ failures	Developed from HBV-ACLF cohort; good regional fit	Limited generalizability; retrospective	Low-moderate
CLIF-C ACLF score	Bilirubin, creatinine, INR, organ failures	Tailored for ACLF; good short-term	Requires multiple parameters; complex	Low-moderate
AARC score	Bilirubin, INR, lactate, creatinine, encephalopathy	Useful in Asian cohorts; emphasizes metabolic stress	Limited global validation; static	Low-moderate
AFP dynamics	Baseline AFP + serial change	Inexpensive; widely available; reflects regeneration	Confounded by etiology, necrosis, malignancy; not yet standardized	High

ACLF: Acute-on-chronic liver failure; AFP: Alpha-fetoprotein; CTP: Child-Turcotte-Pugh; MELD: Model for end-stage liver disease; SOFA: Sequential Organ Failure Assessment; COSSH-ACLF: Chinese group on the study of severe hepatitis B-acute-on-chronic liver failure; CLIF-C ACLF: Chronic liver failure-consortium acute-on-chronic liver failure; AARC: Asian Pacific Association for the Study of the Liver acute-on-chronic liver failure research consortium; HBV-ACLF: Hepatitis B virus-related acute-on-chronic liver failure; INR: International normalized ratio; ICU: Intensive care unit; CNS: Central nervous system.