Table 2 Summary of scores employed in the ICU to characterize hepatic and extrahepatic organ failures

APACHE-II

Assess the baseline risk groups being compared in clinical trials and determine prognosis on all patients newly admitted to the ICU

0–77

Cirrhosis

Need for dialysis

–

severe exercise restriction or respiratory dependency

NYHA Class IV

Based on GCS

10: 15%

20: 40%

 > 34: 85%

[121]

Components:

History of severe organ failure (Heart Failure Class IV; cirrhosis; chronic lung disease, or dialysis-dependent); Age; Temperature; MAP; pH; Heart rate/pulse; Respiratory rate; Sodium: Potassium; Creatinine; Acute renal failure; Hematocrit; White blood cell count; GCS; and FiO₂

SOFA

Determine level of organ dysfunction and mortality risk in ICU patients

0–24

Bilirubin ≥ 6 mg/dl

Creatinine ≥ 3.5 mg/dl

Plat < 50,000

PaO₂/FiO₂ < 200 and MV

High-dose vasopressors

GCS < 13

6: 21%

10: 50%

 > 14: 95%

[12]

Components:

FiO₂/PaO₂ (and MV); Platelets; GCS; Bilirubin; MAP (use of vasopressors); and Creatinine (or urine output)

CLIF-SOFA

Modified SOFA score, which had been specifically developed for the CANONIC study with patients with cirrhosis hospitalized for an acute decompensation

0–24

Bilirubin ≥ 12 mg/dl

Creatinine ≥ 2.0 mg/dl

INR ≥ 2.5

PaO₂/FiO₂ < 200

or

SpO₂/FiO₂ < 214

Use of dopamine, dobutamine or terlipressin

HE ≥ III

See SOFA Score

[6]

Components:

FiO₂/PaO₂ or SpO₂/PaO₂ (and MV); INR; Hepatic Encephalopathy; Bilirubin; MAP (use of vasopressors); and Creatinine (or urine output)

CLIF-C OF and CLIF-C ACLF

CLIF-C OF: Simpler and validated organ failure score for the diagnosis and grading of ACLF

CLIF-C ACLF: Specific prognostic score for ACLF obtained from the combination of CLIF-C OF, age and white blood cell count

6–18

Bilirubin ≥ 12 mg/dl

Creatinine ≥ 2.0 mg/dl

INR ≥ 2.5

PaO₂/FiO₂ < 200

or

SpO₂/FiO₂ < 214

Use of vasopressors

HE ≥ III

ACLF 1: 22%

ACLF 2: 32%

ACLF 3: 77%

[51]

Components:

CLIF-C OF: Bilirubin; Creatinine; Need for RRT; HE Grade; INR, MAP (use of vasopressors); FiO₂/PaO₂ or SpO₂/PaO₂ (and MV)

CLIF-C ACLF: Age; White blood cell count; and CLIF-C OF score

AARC ACLF

Prognostication and timely referral for liver transplantation. The score grades liver failure. The cutoff values for each system failure in this table are based on the definition of the APASL

5–15

Bilirubin ≥ 5 mg/dl

AKIN criteria:

Creatinine: increase ≥ 0.3 mg/dL, or ≥ 1.5–2 × from baseline

Urine output < 0.5 mL/kg per hour for > 6 h

INR ≥ 1.5

–

–

HE ≥ III

5–7: 12.7%

8–10: 44.5%

11–15: 85.9%

[47]

Components:

Bilirubin, HE Grade, INR, Lactate, Creatinine

NACSELD ACLF

Facilitate prognosis determination in both infected and uninfected individuals with cirrhosis

Cirrhosis

Need for RRT

–

Need for MV

Shock: MAP < 60 mmHg

HE ≥ III

1 OF: 37%

2 OF: 49%

3 OF: 64%

 ≥ 4 OF: 77%

[45]

Components:

Cirrhosis; Need for RRT; Need for MV; MAP; and HE

MELD

Determine prognosis and prioritize receipt of liver transplantation

6–40

The MELD score does not define the severity of different organ systems. It is less accurate for mortality prognosis than other scores

[122]

Components:

Need for dialysis; Creatinine; Bilirubin; and INR

MELD-Na

The MELD-Na may improve upon the MELD score for liver cirrhosis

6–40

The MELD-Na score does not define the severity of different organ systems. The MELD-Na has been found to have a better fit for mortality prediction compared to the MELD score alone

20: 4%

26: 15%

 > 32: 65%

[123]

Components:

Need for dialysis; Creatinine; Bilirubin; INR; and Sodium

Child–Pugh

Prognosis of patients with cirrhosis

5–15

The Child–Pugh score does not define the severity of different organ systems apart from liver. More recent scores like the MELD score and MELD-Na have become more used given their better prognostic value

[124, 125]

Components:

Bilirubin; Albumin; INR; Ascites; HE