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.
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.
Introduction: Acute kidney injury (AKI) is a frequent and life-threatening complication of cirrhosis, with management often complicated by inaccurate assessment of intravascular volume and the presence of cirrhotic cardiomyopathy (CCM). This prospective study evaluated whether...
Introduction: Acute-on-chronic liver failure (ACLF) is characterized by overwhelming systemic inflammation and immune dysregulation, leading to high short-term mortality. This study used advanced single-cell and spatial transcriptomic technologies to define the immune landscape of ACLF...
Introduction: Adults with Fontan-type circulation are increasingly recognized to develop Fontan-associated liver disease and portal hypertension. This prospective study explored the prevalence, anatomical distribution, and hemodynamic characteristics of esophageal varices (EV), with particular emphasis on...
Introduction: Acute-on-chronic liver failure (ACLF) is characterized by overwhelming systemic inflammation and immune dysregulation, leading to high short-term mortality. This study used advanced single-cell and spatial transcriptomic technologies to define the immune landscape of ACLF...
Introduction: Despite advances in the management of portal hypertension, mortality after variceal bleeding remains high in patients with cirrhosis. Experimental and clinical studies suggest that statins may improve portal hypertension and hepatic vascular function. This...
Introduction: Acute liver failure (ALF) complicated by cerebral oedema carries a high risk of early mortality, primarily due to hyperammonemia and intracranial hypertension. The optimal timing of continuous renal replacement therapy (CRRT) in these critically...
We are pioneers in clinical intelligence, dedicated to helping gastroenterologists harness the power of artificial intelligence to drive precision, efficiency, and patient growth.