Consensus versus Outcome-based Definitions of Acute-on-chronic Liver Failure: Implications for Risk Stratification and Case Identification (IMAGE)
Caption
The consensus ACLF framework and A-TANGO classification identify fundamentally different patient populations. The consensus definition captures a smaller, liver-centered phenotype, whereas A-TANGO identifies a broader population that includes a substantial intermediate-risk group with clinically meaningful mortality. These findings demonstrate that harmonization, as currently operationalized, may come at the cost of reduced clinical accuracy, sensitivity, and underdiagnosis of important high-risk phenotypes, with significant potential clinical and regulatory consequences. Rather than replacing outcome-based definitions, future efforts toward harmonization should build upon them. A unified framework must preserve the link between organ failure and mortality that underpins the clinical utility of ACLF, ensuring that convergence enhances rather than diminishes the ability to identify patients at risk of mortality.
Credit
Rajiv Jalan, Cornelius Engelmann, Ajay D, useja, Hai Li, Jinjun Chen
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License
CC BY-NC