Acute-on-Chronic Liver Failure (ACLF)NCT07734896
Evaluating Novel Scoring Systems to Predict Outcomes in Acute-on-Chronic Liver Failure
An observational study of Acute-on-Chronic Liver Failure (ACLF) and Liver Cirrhosis, run by Assiut University.
Trial summary
Acute-on-chronic liver failure (ACLF) is a serious condition where a patient with long-term liver disease suddenly experiences severe liver worsening and failure of other organ systems, such as the kidneys or lungs. Read more about this study
- Who is it for?
- Ages 18 years and older
- Conditions the study is for
- Acute-on-Chronic Liver Failure (ACLF), Liver Cirrhosis, End Stage Liver Disease
- How many people
- 100 participants
- Where
- No sites listed yet
- Study dates
- Aug 2026to Sep 2027
- Phase
- Observational
- Are there results?
- Not yet: the study is under way
Key requirements
Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.
- Ages 18 years and older
- All sexes
- Adult, Older adult
Study population: Patients diagnosed with Acute-on-Chronic Liver Failure (ACLF) according to the EASL-CLIF diagnostic criteria who are admitted to the Intensive Care Unit (ICU) of the Tropical Medicine and Gastroenterology Department at Al-Rajhi University Hospital.
Who may be able to join
- Patients aged 18 years or older.
- Diagnosed with Acute-on-Chronic Liver Failure (ACLF) fulfilling the diagnostic criteria according to EASL-CLIF.
- Admitted to the Intensive Care Unit (ICU) of the Tropical Medicine and Gastroenterology Department, Al-Rajhi University Hospital.
Who cannot join
- Patients with hepatocellular carcinoma.
- Patients with advanced extrahepatic malignancy.
- Pregnant females.
- Patients younger than 18 years old.
- Patients with incomplete clinical or laboratory data.
- Patients or first-degree relatives refusing participation.
About this study
Official title: Evaluation of Novel Scores for Prediction of Outcomes in Patients With Acute-on-Chronic Liver Failure
Acute-on-chronic liver failure (ACLF) is a serious condition where a patient with long-term liver disease suddenly experiences severe liver worsening and failure of other organ systems, such as the kidneys or lungs. ACLF is associated with a high risk of short-term death, making early and accurate prediction of patient outcomes essential for guiding medical decisions.
Conventional scoring systems, such as the Child-Pugh and Model for End-Stage Liver Disease Sodium (MELD-Na) scores, are widely used to assess liver disease severity. However, these traditional models may not fully capture the intense systemic inflammation and multiorgan failure characteristic of ACLF. Recently, novel prognostic scoring models, specifically the CLIF-C ACLF-D score and the MELD-complication score, have been developed to better predict patient outcomes by integrating markers of inflammation, organ dysfunction, and clinical complications.
Read more
This study aims to evaluate and validate the clinical usefulness of these novel scoring models compared to conventional scores in predicting in-hospital and 28-day mortality among patients admitted with ACLF.
Participants enrolled in this prospective observational study will be recruited from the Intensive Care Unit (ICU) of the Tropical Medicine and Gastroenterology Department at Al-Rajhi University Hospital. Upon admission, participants will undergo routine clinical examinations, laboratory testing, and imaging. The various risk scores will be calculated at baseline. Participants will be monitored throughout their hospital stay, and their survival status will be followed for 28 days after admission to compare the accuracy of each scoring system.
Read the detailed description
Acute decompensation in liver cirrhosis is the primary cause of hospitalization among cirrhotic patients. Acute-on-chronic liver failure (ACLF) represents a distinct, severe clinical entity characterized by systemic inflammation, single- or multiple-organ failures, and high short-term mortality. While traditional scoring systems like the Child-Pugh and Model for End-Stage Liver Disease Sodium (MELD-Na) scores are routinely utilized, they may fail to capture the complex inflammatory response and multiorgan involvement inherent to ACLF.
To improve prognostic estimation, novel predictive tools, including the CLIF-C ACLF-D score and the MELD-complication score, have been introduced, incorporating inflammatory parameters and complication markers. Validation of these prognostic models across distinct patient populations is necessary prior to broad implementation. This study evaluates the prognostic performance of these novel models in patients with ACLF admitted to the Intensive Care Unit (ICU).
All enrolled participants will undergo systematic evaluation upon admission:
- Clinical and Demographic Assessment: Full patient history (demographics, etiology of underlying chronic liver disease, previous episodes of decompensation, drug history) and comprehensive physical examination (vital signs, grade of hepatic encephalopathy, jaundice, asterixis, edema, and clinical signs of infection or ascites/pleural effusion).
- Laboratory Diagnostics: Complete blood count with differential, liver function tests (total and direct bilirubin, serum albumin), renal function parameters (serum creatinine, blood urea nitrogen), coagulation profile (prothrombin time, INR), serum electrolytes (sodium, potassium), C-reactive protein (CRP), arterial blood gas analysis, viral hepatitis markers (HBsAg, anti-HCV), ascitic fluid analysis (if applicable), and biological cultures from suspected infectious foci.
- Imaging: Abdominal ultrasonography (evaluating hepatic architecture, portal vein parameters, splenic dimensions, collateral circulation, biliary structure, renal status, ascites) and chest radiography.
- Scoring Calculation: Baseline risk scores-including Child-Pugh, MELD-Na, CLIF-C OF, CLIF-C ACLF, CLIF-C ACLF-D, and MELD-complication scores-will be calculated at admission using standard mathematical formulas and validated online platforms.
Participants will be followed throughout their hospital stay and up to 28 days following admission. Survival outcomes will be confirmed in-hospital or post-discharge via telephone follow-up or clinical visits.
- Keywords
- CLIF-C ACLF-D Score, MELD-Complication Score, MELD-Na Score, Child-Pugh Score, Prognostic Scores
- Medical subject headings
- Acute-On-Chronic Liver Failure, Liver Cirrhosis, End Stage Liver Disease
What participants receive
What participants receive. In a randomised study each person is assigned to one group by chance.
| Study group | Role | What they receive |
|---|---|---|
| ACLF Patients | Patients aged 18 years or older diagnosed with Acute-on-Chronic Liver Failure (ACLF) according to EASL-CLIF criteria and admitted to the Intensive Care Unit of the Tropical Medicine and Gastroenterology Department at Al-Rajhi University Hospital. All patients will undergo full clinical, laboratory, and radiological evaluations at baseline, followed by calculation of novel (CLIF-C ACLF-D, MELD-complication) and conventional (Child-Pugh, MELD-Na, CLIF-C ACLF) prognostic scores to predict short-term outcomes. |
What is being measured
The primary outcome is the main question the study is designed to answer.
28-Day All-Cause Mortality Rate
Percentage of participants with Acute-on-Chronic Liver Failure (ACLF) who die from any cause within 28 days following hospital admission. Survival status will be evaluated during the hospital stay and confirmed post-discharge via clinic visits or telephone follow-up.
Measured: 28 days post-hospital admission
Secondary outcomes (2)
In-Hospital All-Cause Mortality Rate
Percentage of participants with Acute-on-Chronic Liver Failure (ACLF) who die from any cause during their hospital stay.
Measured: From date of hospital admission up to hospital discharge, assessed up to 28 days
Prognostic Performance of the CLIF-C ACLF-D Score for 28-Day Mortality
Predictive accuracy of the novel CLIF-C ACLF-D score measured by the Area Under the Receiver Operating Characteristic Curve (AUROC) to predict 28-day all-cause mortality.
Measured: Baseline (day 1 of admission) up to 28 days
Timeline
From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.
- First posted29 Jul 2026
- Study startAug 2026 (estimated)
- Primary completionAug 2027 (estimated)
- Study completionSep 2027 (estimated)
Resources
- Official record on ClinicalTrials.govThe registry entry this page is built from, with its full change history.
- Other trials for Acute-on-Chronic Liver Failure (ACLF)Studies of the same condition, open and under way.
- More trials run by Assiut UniversityThe sponsor's other registered studies.
- What the trial phases meanHow a treatment moves from first tests in people to approval.
More details
For doctors and researchers: how the study is designed, who runs it, and its registry IDs.
Study design
- Study type
- Observational
- Observational model
- Cohort
- Time perspective
- Prospective
- Enrolment
- 100 participants (estimated)
Sponsor and investigators
- Lead sponsor
- Assiut University
- Sponsor type
- University, hospital or other
- Responsible party
- Principal investigator, Rehab Hassan Abdel-hafiz Hassan, Assiut University
IDs, dates and publications
- ClinicalTrials.gov ID
- NCT07734896
- Sponsor's protocol ID
- Predicting Outcomes in ACLF
- Status last verified
- Jul 2026
- First submitted
- 25 Jul 2026
- Last updated
- 29 Jul 2026
- Results posted
- No
Study at a glance
From the registry record, last updated by the sponsor on 29 Jul 2026. Recruitment status is as the sponsor reported it: confirm with the study team.
- Official title
- Evaluation of Novel Scores for Prediction of Outcomes in Patients With Acute-on-Chronic Liver Failure
- ClinicalTrials.gov ID
- NCT07734896
- Acronym / sponsor ID
- Predicting Outcomes in ACLF
- Keywords
- CLIF-C ACLF-D Score, MELD-Complication Score, MELD-Na Score, Child-Pugh Score, Prognostic Scores
- Study type
- Observational
- Recruitment status
- Not yet recruiting
- Enrolment
- 100 participants (estimated)
- Lead sponsor
- Assiut UniversityUniversity, hospital or other
- Study start
- Aug 2026 (estimated)
- Primary completion
- Aug 2027 (estimated)
- Study completion
- Sep 2027 (estimated)
- First posted
- 29 Jul 2026 (actual)
- Results
- Not posted in the source record
Clinical summary
The research question as the sponsor registered it. This describes what the study plans to test, not what it found.
Acute-on-chronic liver failure (ACLF) is a serious condition where a patient with long-term liver disease suddenly experiences severe liver worsening and failure of other organ systems, such as the kidneys or lungs. ACLF is associated with a high risk of short-term death, making early and accurate prediction of patient outcomes essential for guiding medical decisions.
Conventional scoring systems, such as the Child-Pugh and Model for End-Stage Liver Disease Sodium (MELD-Na) scores, are widely used to assess liver disease severity. However, these traditional models may not fully capture the intense systemic inflammation and multiorgan failure characteristic of ACLF. Recently, novel prognostic scoring models, specifically the CLIF-C ACLF-D score and the MELD-complication score, have been developed to better predict patient outcomes by integrating markers of inflammation, organ dysfunction, and clinical complications.
This study aims to evaluate and validate the clinical usefulness of these novel scoring models compared to conventional scores in predicting in-hospital and 28-day mortality among patients admitted with ACLF.
Participants enrolled in this prospective observational study will be recruited from the Intensive Care Unit (ICU) of the Tropical Medicine and Gastroenterology Department at Al-Rajhi University Hospital. Upon admission, participants will undergo routine clinical examinations, laboratory testing, and imaging. The various risk scores will be calculated at baseline. Participants will be monitored throughout their hospital stay, and their survival status will be followed for 28 days after admission to compare the accuracy of each scoring system.
Detailed description
Acute decompensation in liver cirrhosis is the primary cause of hospitalization among cirrhotic patients. Acute-on-chronic liver failure (ACLF) represents a distinct, severe clinical entity characterized by systemic inflammation, single- or multiple-organ failures, and high short-term mortality. While traditional scoring systems like the Child-Pugh and Model for End-Stage Liver Disease Sodium (MELD-Na) scores are routinely utilized, they may fail to capture the complex inflammatory response and multiorgan involvement inherent to ACLF.
To improve prognostic estimation, novel predictive tools, including the CLIF-C ACLF-D score and the MELD-complication score, have been introduced, incorporating inflammatory parameters and complication markers. Validation of these prognostic models across distinct patient populations is necessary prior to broad implementation. This study evaluates the prognostic performance of these novel models in patients with ACLF admitted to the Intensive Care Unit (ICU).
All enrolled participants will undergo systematic evaluation upon admission:
- Clinical and Demographic Assessment: Full patient history (demographics, etiology of underlying chronic liver disease, previous episodes of decompensation, drug history) and comprehensive physical examination (vital signs, grade of hepatic encephalopathy, jaundice, asterixis, edema, and clinical signs of infection or ascites/pleural effusion).
- Laboratory Diagnostics: Complete blood count with differential, liver function tests (total and direct bilirubin, serum albumin), renal function parameters (serum creatinine, blood urea nitrogen), coagulation profile (prothrombin time, INR), serum electrolytes (sodium, potassium), C-reactive protein (CRP), arterial blood gas analysis, viral hepatitis markers (HBsAg, anti-HCV), ascitic fluid analysis (if applicable), and biological cultures from suspected infectious foci.
- Imaging: Abdominal ultrasonography (evaluating hepatic architecture, portal vein parameters, splenic dimensions, collateral circulation, biliary structure, renal status, ascites) and chest radiography.
- Scoring Calculation: Baseline risk scores-including Child-Pugh, MELD-Na, CLIF-C OF, CLIF-C ACLF, CLIF-C ACLF-D, and MELD-complication scores-will be calculated at admission using standard mathematical formulas and validated online platforms.
Participants will be followed throughout their hospital stay and up to 28 days following admission. Survival outcomes will be confirmed in-hospital or post-discharge via telephone follow-up or clinical visits.
Study design
- Observational model
- Cohort
- Time perspective
- Prospective
- Number of arms
- 1
| Arm | Type | Receives |
|---|---|---|
| ACLF Patients | – | –Patients aged 18 years or older diagnosed with Acute-on-Chronic Liver Failure (ACLF) according to EASL-CLIF criteria and admitted to the Intensive Care Unit of the Tropical Medicine and Gastroenterology Department at Al-Rajhi University Hospital. All patients will undergo full clinical, laboratory, and radiological evaluations at baseline, followed by calculation of novel (CLIF-C ACLF-D, MELD-complication) and conventional (Child-Pugh, MELD-Na, CLIF-C ACLF) prognostic scores to predict short-term outcomes. |
Who may qualify
- Ages
- 18 years and older
- Sex
- All
- Age groups
- Adult, Older adult
- Study population
- Patients diagnosed with Acute-on-Chronic Liver Failure (ACLF) according to the EASL-CLIF diagnostic criteria who are admitted to the Intensive Care Unit (ICU) of the Tropical Medicine and Gastroenterology Department at Al-Rajhi University Hospital.
Key inclusion criteria (3 listed)
- Patients aged 18 years or older.
- Diagnosed with Acute-on-Chronic Liver Failure (ACLF) fulfilling the diagnostic criteria according to EASL-CLIF.
- Admitted to the Intensive Care Unit (ICU) of the Tropical Medicine and Gastroenterology Department, Al-Rajhi University Hospital.
Key exclusion criteria (6 listed)
- Patients with hepatocellular carcinoma.
- Patients with advanced extrahepatic malignancy.
- Pregnant females.
- Patients younger than 18 years old.
- Patients with incomplete clinical or laboratory data.
Eligibility is decided by the study team after screening; this overview does not establish that a patient qualifies. Full inclusion and exclusion criteria.
Primary outcome
28-Day All-Cause Mortality Rate
Time frame: 28 days post-hospital admission
Percentage of participants with Acute-on-Chronic Liver Failure (ACLF) who die from any cause within 28 days following hospital admission. Survival status will be evaluated during the hospital stay and confirmed post-discharge via clinic visits or telephone follow-up.
2 secondary outcomes
In-Hospital All-Cause Mortality Rate
Time frame: From date of hospital admission up to hospital discharge, assessed up to 28 days
Prognostic Performance of the CLIF-C ACLF-D Score for 28-Day Mortality
Time frame: Baseline (day 1 of admission) up to 28 days
Results and safety
This study is still under way. Results are not available in the source record yet.
Research links
- Official record on ClinicalTrials.govLast updated by the sponsor 29 Jul 2026.
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Referral and contact
AzTrials does not enrol participants or take referrals. Contact the study team or a site listed below; they decide who can take part.
The record lists no contact. Use the official record to reach the sponsor.
Questions about this trial
What is this clinical trial studying?
An observational study of Acute-on-Chronic Liver Failure (ACLF) and Liver Cirrhosis, run by Assiut University.
The full registered description is in the About this study section and the official record.
Who may be eligible to take part?
The sponsor lists 3 inclusion and 6 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.
Is this clinical trial currently recruiting?
The record says: opening soon, as of the sponsor's last update on 29 Jul 2026. Status can change between updates, so confirm with the study contact before making plans.
What are the possible benefits and risks?
They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.
Are results available for this study?
This study is still under way. Results are not available in the source record yet.
How can a doctor refer a patient or contact the research team?
The record lists no contact. The official record names the sponsor, who can be asked directly. AzTrials does not enrol participants or take referrals.
What does the primary outcome measure?
28-Day All-Cause Mortality Rate (time frame: 28 days post-hospital admission). It is what the study was designed to measure, not a finding.
Where can I read the original study information?
Does a listing mean the treatment is approved or proven to work?
No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.
How often is this information updated?
AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 29 Jul 2026.