Table 2.

The advantages and limitations of the various prognostic models for Acute-on-Chronic liver failure (ACLF).

Model	Parameters	Advantages	Limitations
CTP	HE; Ascites; Alb; PT; INR	The calculation is simple, the evaluation index is easy to obtain clinically, and the impact of portal hypertension on the disease is taken into account	HE and ascites grading have certain subjectivity in clinical practice, and sometimes they cannot truly reflect the severity of the patient's condition and lack effective indicators to evaluate renal function
MELD	TBil; Cre; INR; Causes	The parameters are objective, taking into account renal failure, liver failure and coagulation disorders, and can accurately evaluate the condition of patients with liver failure	The failure of organs such as brain and circulation, portal hypertension, ascites and other complications were not considered, resulting in the inconsistency between the severity of the patient's condition and the MELD level, and it is easy to miss the best transplantation window period
MELD-Na	TBil; Cre; INR; Causes; Na	Compared with Cre, serum sodium can predict renal function damage earlier and more sensitive, which is mainly suitable for patients with hyponatremia	The impact of extrahepatic organ failure on the prognosis of patients is not fully taken into account, which cannot truly reflect the severity of the underlying systemic disease. In addition, the serum sodium level is easily affected by many factors such as blood volume and diuretics
EASL-CLIF	HE; TBil; Cre; INR; MAP; PaO2/FiO2; SPO2/FiO2; WBC	The severity of liver, renal, central nervous system, coagulation, circulatory, and respiratory function was comprehensively assessed to further stratifiate patients in different mortality risk subgroups	It is established based on Westerners who mostly have alcohol-related liver disease and hepatitis C, and the ability to evaluate HBV-ACLF needs to be explored, and the calculation of the scoring model is complex, which is not good for clinical operation
AARC	HE; TBil, INR, Cre; lactate	The calculation is simple, the index is easy to obtain, and covers the functional evaluation of other systems, which is more suitable for the actual situation of ALCF patients in the Asia-Pacific region	At present, there are few studies on the application of this model, and prospective and multi-center validation is needed
COSSH	HE; TBil; INR; Neut; Age: BUN	The model was established based on a multi-center and large sample of hepatitis B patients, and the risk stratification of HBV-ACLF was optimized	The population is HBV-ACLF patients, and the prognosis of ACLF caused by other causes is not considered. However, too many scoring indicators are not good for clinicians to quickly evaluate the prognosis and disease classification of ACLF patients