What is the clinical significance of the Alfed score (Acute Liver Failure Early Detection score) in patient assessment?

The "ALFED Score" Does Not Exist in Medical Literature

There is no validated clinical scoring system called the "ALFED score" (Acute Liver Failure Early Detection score) in current medical practice or published guidelines. You may be confusing this with other established prognostic scoring systems used in acute liver failure (ALF) or acute-on-chronic liver failure (ACLF).

Validated Scoring Systems for Acute Liver Failure

For Acute Liver Failure (ALF)

The MELD score is the recommended prognostic tool for ALF, with a cutoff of 30.5 predicting need for liver transplantation. 1

• MELD score demonstrates superior sensitivity (77%) compared to King's College Criteria (61%) for predicting mortality in ALF patients 1
• The pooled specificity for MELD is 72%, while King's College Criteria shows higher specificity at 86% 1
• MELD offers the opportunity to optimize specificity without losing significant sensitivity 1

For Acute-on-Chronic Liver Failure (ACLF)

The CLIF-C organ failure (CLIF-C OF) score is the gold standard for diagnosing and prognosticating ACLF, evaluating six organ systems (liver, kidney, brain, coagulation, circulation, respiration). 1

• CLIF-C ACLF scores that incorporate organ failures demonstrate superior prognostic accuracy compared to conventional scores like MELD or MELD-Na 1
• The CLIF-C OF score has been validated internationally and should be used for sequential assessment at days 3-7 to determine response to intervention 1, 2
• Patients with ACLF-3 who show improvement by day 3 have 40% mortality versus 79% in those who do not improve 1

Alternative Scoring Systems You May Be Referencing

NACSELD Score

• Evaluates only four organ systems (brain, kidneys, circulation, respiration) 1
• Underestimates mortality risk by excluding liver and coagulation failures 1
• Misses 62.7% of patients with CLIF-C OF-defined ACLF who have 28-day mortality of 21.1% 1

AARC Score (APASL)

• Includes bilirubin, creatinine, lactate, INR, and hepatic encephalopathy 1
• Applied only after ACLF diagnosis is made using APASL criteria 1
• Underestimates 28-day and 90-day mortality compared to CLIF-C criteria 1

Clinical Pitfalls

• Do not use unvalidated or non-existent scoring systems for clinical decision-making - this could lead to inappropriate triage, delayed transplant listing, or premature withdrawal of care
• Always verify the scoring system name and methodology before applying it to patient care
• For ALF: Use MELD ≥30.5 as the threshold for transplant evaluation 1
• For ACLF: Use CLIF-C OF score with serial assessments rather than single time-point evaluation 1, 2