A-TANGO for ACLF: Journal of Hepatology | February 2026

Introduction

Acute-on-chronic liver failure (ACLF) is a severe syndrome characterized by acute decompensation of cirrhosis, multiorgan failure, and high short-term mortality. The current EASL-CLIF criteria have been widely used for diagnosis and prognostication, but they have important limitations, particularly in accurately defining organ failure thresholds and stratifying risk within severe disease categories. With emerging therapies and increasing emphasis on clinical trials in ACLF, there is a growing need for more precise and reproducible scoring systems. This study introduces the A-TANGO organ failure score, developed using large global cohorts to improve diagnosis, risk stratification, and applicability in clinical trials.

Summary

The A-TANGO score was derived from nearly 4,000 patients across Europe and Latin America and validated in large independent cohorts from India and China, making it one of the most robust global ACLF datasets to date. The score refines organ dysfunction thresholds and introduces a more granular classification, including a new ACLF grade 4 to better capture patients with extremely high mortality risk. Compared with the traditional CLIF-C OF score, A-TANGO identifies a greater number of organ failures and increases ACLF diagnosis rates, thereby improving patient classification. Importantly, despite identifying more patients with ACLF, the score maintains strong predictive accuracy for short-term mortality. The study also introduces two additional prognostic models incorporating inflammatory markers, which further enhance risk prediction. Overall, A-TANGO provides a more sensitive and clinically relevant framework for identifying high-risk patients, guiding management decisions, and defining endpoints in ACLF clinical trials.

Conclusion

The A-TANGO organ failure score represents a significant advancement in the field of ACLF by improving diagnostic precision without compromising prognostic performance. Its validation across diverse global populations supports its potential as a new standard for both clinical practice and research. By enabling better identification of high-risk patients and providing more reliable endpoints, A-TANGO is likely to play a key role in the development and evaluation of future therapies in ACLF.