Subsequently, we prospectively validated a revised CTP scoring system by replacing the subjective clinical assessment of ascites and encephalopathy in the CTP score with objectively quantified plasma IGF-1 levels to create new IGF/CTP score classes (IGF/CTP-A, -B, and -C, with A indicating low risk, B indicating intermediate risk, and C indicating high risk). Here, IGF1 is linked to Encephalopathy.