Objective: To validate the chronic liver failure-sequential organ failure assessment [CLIF-SOFA] tool for the diagnosis of acute-onchronic liver failure [ACLF] in hospitalized Thai patients with cirrhosis and to evaluate the clinical significance of urine neutrophil gelatinase-associated lipocalin [uNGAL] in combination with the CLIF-SOFA score to predict ACLF mortality.

Materials and Methods: Seventy-seven patients were enrolled. The authors generated new ACLF diagnostic criteria by combining the uNGAL level with the original renal failure criteria from the CLIF-SOFA score [CLIF/NGAL score]. The primary endpoint was the 30-day mortality rate [MR].

Results: ACLF patients, according to the original CLIF-SOFA score, had a 43.7% MR in comparison to the non-ACLF patients, who had a 13.3% MR. The calculated odds ratio [OR] was 3.28, with an area under the ROC [AUROC] of 0.750 (95% CI 0.62 to 0.88, p = 0.001). The CLIF/NGAL score demonstrated better prognostic prediction ability. The MR was 38.6%, with an OR of 4.03 (95% CI 1.29 to 12.61) and an AUROC of 0.772 (95% CI 0.65 to 0.90, p<0.001).

Conclusion: The CLIF-SOFA score is valid for ACLF diagnosis among Thai patients. Moreover, the authors new proposed criteria, the CLIF/NGAL score, demonstrated better potential than the original criteria for ACLF mortality prediction.

Keywords: Renal failure, NGAL, Acute-on-chronic liver failure, Cirrhosis, Mortality