THU-053-Usefulness of lactate-free Asian Pacific Association for The Study of Liver acute-on-chronic liver failure research consortium ACLF score for predicting short-term mortality in patient with alcoholic liver disease

Background and Aims: Acute-on-chronic liver failure (ACLF) is an acute deterioration of chronic liver disease with high short-term mortality. The inclusion or exclusion of previously decompensated cirrhosis (DC) in the diagnostic criteria of ACLF defined by the Asian Pacific Association for the Study of the Liver (APASL-ACLF) has not been conclusive. We aimed to evaluate the prognostic impact of decompensated cirrhosis in ACLF.Methods: We retrospectively collected a cohort of patients with a diagnosis of APASL-ACLF (with or without DC) hospitalized from 2012 to 2020 at three liver units in tertiary hospitals. Baseline characteristics and survival data at 28, 90, 180, 360, 540, and 720 days were collected.Results: Of the patients assessed using APASL-ACLF criteria without the diagnostic indicator of chronic liver disease, 689 patients were diagnosed with ACLF, of whom 435 had no decompensated cirrhosis (non-DC-ACLF) and 254 had previously decompensated cirrhosis (DC-ACLF). The 28-, 90-, 180-, 360-, 540-, and 720-day mortality were 24.8, 42.9, 48.7, 57.3, 63.4, and 68.1%, respectively, in DC-ACLF patients, which were significantly higher than in non-DC-ACLF patients (p < 0.05). DC was independently associated with long-term (180/360/540/720 days) but not short-term (28/90 days) mortality in patients with ACLF. Age, total bilirubin, international normalized ratio, and hepatic encephalopathy were independent risk factors for short- and long-term mortality risk in ACLF patients (p < 0.05).Conclusions: Patients with DC-ACLF have a higher mortality rate, especially long-term mortality, compared to non-DC-ACLF patients. Therefore, DC should be included in the diagnostic criteria of APASL-ACLF and treated according to the ACLF management process.

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Use of skeletal muscle index as a predictor of short-term mortality in patients with acute-on-chronic liver failure

Scientific Reports ◽

10.1038/s41598-021-92087-1 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Tongzeng Li ◽

Manman Xu ◽

Ming Kong ◽

Wenyan Song ◽

Zhongping Duan ◽

...

Keyword(s):

Skeletal Muscle ◽

Liver Disease ◽

Liver Failure ◽

Chronic Liver Disease ◽

Serum Bilirubin ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Short Term ◽

Skeletal Muscle Index ◽

Short Term Mortality

AbstractSarcopenia is a well-recognized factor affecting the prognosis of chronic liver disease, but its impact on acute decompensation underlying chronic liver disease is unknown. This study evaluated the impact of sarcopenia on short-term mortality in patients with acute-on-chronic liver failure (ACLF). One hundred and seventy-one ACLF patients who underwent abdominal CT between 2015 and 2019 were retrospectively included in this study. Skeletal muscle index at the third lumbar vertebrae (L3-SMI) was used to diagnose sarcopenia.The ACLF patients in this study had a L3-SMI of 41.2 ± 8.3 cm2/m2 and sarcopenia was present in 95/171 (55.6%) patients. Body mass index (BMI), cirrhosis, and higher serum bilirubin were independently associated with sarcopenia. Following multivariate Cox regression analysis, cirrhosis (hazard ratio (HR) 2.758, 95%CI 1.323–5.750), serum bilirubin (HR 1.049, 95%CI 1.026–1.073), and international normalized ratio (INR) (HR 1.725, 95%CI 1.263–2.355) were associated with 3-month mortality (P < 0.05), whereas L3-SMI and sarcopenia were not. A subgroup analysis of the factors related to sarcopenia showed that sarcopenia was still not predictive of short-term outcome in ACLF patients. L3-SMI and sarcopenia are not associated with short-term mortality in patients with ACLF.

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Evaluation of treatment outcome in patients with acute-on-chronic liver failure using clinical scores

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh190511093m ◽

2020 ◽

Vol 148 (3-4) ◽

pp. 153-159

Author(s):

Tamara Milovanovic ◽

Milica Stojkovic-Lalosevic ◽

Sanja Dragasevic ◽

Nevena Jocic ◽

Marko Baralic ◽

...

Keyword(s):

Liver Disease ◽

Liver Failure ◽

High Mortality ◽

Chronic Liver ◽

Apache Ii ◽

Prognostic Scores ◽

Chronic Liver Failure ◽

Short Term ◽

Short Term Mortality ◽

Precise Prediction

Introduction/Objective. Due to a very high mortality risk, acute-on-chronic liver failure (ACLF) patients require early identification and intensive treatment. Precise prediction is crucial for determining the urgency degree and therapy appropriateness, considering high mortality and multitude of clinical resources. The aim of our study was to determine the exact cut-off values of various prognostic scores in the prediction of morality of ACLF. Methods. This prospective study includes chronic liver disease (CLD) patients, admitted due to decompensation, that were subsequently diagnosed with ACLF at the Emergency unit. All patients were evaluated based on various prognostic scores, including Child?Pugh, MELD Na, MELD, SOFA, APACHE II, and CLIF C, which were calculated on admission. Results. Alcoholic liver disease (ALD) was the most common underlying CLD cause (77.9%), followed by viral (8.6%), autoimmune (7.7%), and other causes (5.8%). A total of 37.5% of the patients died at the end of the first month of treatment. Average values of Child?Pugh, MELD Na, MELD, SOFA, APACHE II, and CLIF C scores were significantly higher in patients who died compared to survivors (p < 0.05). CLIF C score showed the best performance with a cut-off value of 50.5, with a sensitivity of 94.9% and specificity of 40%. Conclusion. ACLF remains a condition with a high short-term mortality. Of all of the scores examined in our study, CLIF C proved to be the best scoring system for predicting short term and end of treatment mortality in patients with ACLF.

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Persistently Increased Resting Energy Expenditure Predicts Short-Term Mortality in Patients with Acute-on-Chronic Liver Failure

Annals of Nutrition and Metabolism ◽

10.1159/000487604 ◽

2018 ◽

Vol 73 (1) ◽

pp. 2-9

Author(s):

Jia Yao ◽

Xiaoshuang Zhou ◽

Hui Wang ◽

Lili Yuan ◽

Yu Chen ◽

...

Keyword(s):

Liver Disease ◽

Hepatitis B ◽

Energy Expenditure ◽

Liver Failure ◽

Resting Energy Expenditure ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Short Term ◽

Short Term Mortality ◽

Resting Energy

Objective: Hypermetabolism based on measurements of resting energy expenditure (REE) is suggested to be a potential biomarker for predicting the clinical outcomes of some diseases. We aimed to evaluate the potential value of hypermetabolism for predicting the short-term (28-day) mortality of patients with hepatitis B virus-related acute-on-chronic liver failure (HBV-ACLF). Methods: A total of 105 HBV-ACLF patients, 30 chronic hepatitis B (CHB) patients and 30 healthy controls (HCs) were included in this study. The REE was measured using indirect calorimetry in the morning after 8–10 h of fasting. The predicted REE (REEHB) was determined using Harris-Benedict equation. Persistent hypermetabolism was defined as the REE:REEHB ratio > 1.20 at day 1 and day 7 after admission. The severity of liver disease was estimated using the Model for End-Stage Liver Disease (MELD). Clinical and biochemical variables were determined using blood samples ordered upon admission. These variables were compared between nonsurviving and surviving patients who were classified according to the 28-day mortality. Results: The frequency of hypermetabolism at baseline was significantly higher in ACLF patients than that in HCs and CHB patients. Forty-six (43.8%) ACLF patients died within follow-up of 28 days. Persistent hypermetabolism (OR 2.10; 95% CI 1.15–3.69; p = 0.002) and MELD score (OR 1.93; 95% CI 1.47–3.51; p = 0.012) were independent predictive indicators of 28-day mortality. Furthermore, the performance of the 2 variables (persistent hypermetabolism and MELD) together with the area under the receiver operating curve (AUROC: 0.819) was significantly better than that of MELD alone (AUROC: 0.694) for prediction of short-term mortality (p = 0.014). Conclusion: These findings indicate that persistent hypermetabolism is predictive of short-term mortality in this small population.

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Acute on chronic liver failure- etiology, clinical profile, prognostic scores: experience from tertiary care centre of eastern India

International Journal of Research in Medical Sciences ◽

10.18203/2320-6012.ijrms20214425 ◽

2021 ◽

Vol 9 (11) ◽

pp. 3405

Author(s):

Sanatan Behera ◽

Vivek Prakash ◽

Shivam Bajpai ◽

Umesh Chandra Patra ◽

Sushanta Kumar Jena

Keyword(s):

Chronic Hepatitis ◽

Liver Disease ◽

Liver Failure ◽

Chronic Liver Disease ◽

Chronic Liver ◽

Prognostic Scores ◽

Eastern India ◽

Chronic Liver Failure ◽

Short Term ◽

Short Term Mortality

Background: Acute on chronic liver failure (ACLF) is a recently recognised entity in chronic liver disease patients. Data regarding ACLF in terms of clinical presentation, etiology of underlying cirrhosis, precipitating factors, prognostic factors are lacking from eastern India. The present study was undertaken to evaluate the above factors along with the assessment of short-term mortality (4 weeks) in patients of ACLF.Methods: In this prospective observational study, 120 patients diagnosed as ACLF were included. A comparison of complications, biochemical profiles and prognostic scores was made between the survivor and non-survivor groups.Results: Of the 120 ACLF patients included, the mean age was 44.9±8.6 years and the male to female ratio was 2.5:1. Common clinical presentations were jaundice (100%), ascites (88.3%), hepatic encephalopathy (60%). The most common etiology for underlying CLD was alcohol (51.7%) followed by chronic hepatitis B (20%) and chronic hepatitis C (15%) infection. Alcohol hepatitis (40%) followed by hepatotropic viral infections (20%) and drug-induced liver injury (15%) were common identifiable precipitating agents. After a follow-up period of 4 weeks, 56 (46.6%) out of 120 patients died. The presence of sepsis, hyponatremia, renal failure, and coagulopathy was significantly associated with high mortality. Mortality was higher among patients having high Chronic liver failure consortium- acute on chronic liver failure (CLIF-ACLF) grade and closely related to the number of organ failures.Conclusions: ACLF is a rapidly progressive syndrome in chronic liver disease patients, having high short-term mortality.

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Acute-on-chronic liver failure: MELD score 30-day mortality predictability and etiology in a Pakistani population

Pakistan Journal of Surgery and Medicine ◽

10.37978/pjsm.v1i1.103 ◽

2020 ◽

Vol 1 (1) ◽

pp. 29-34

Author(s):

Azza Sarfraz ◽

Muzna Sarfraz ◽

Naeem Abbas Gilani ◽

Javaria Siddiq ◽

Saim Sattar ◽

...

Keyword(s):

Liver Disease ◽

Liver Failure ◽

Viral Hepatitis ◽

Local Population ◽

Meld Score ◽

Chronic Liver ◽

Categorical Variables ◽

Chronic Liver Failure ◽

Short Term ◽

Short Term Mortality

Background: Cirrhosis is a pathological condition that ultimately leads to liver failure. Acute on chronic liver failure (ACLF) has a high short term mortality rate. Viral hepatitis is the most common cause of liver failure in our local population. We carried out this study to identity the 30-day mortality and etiology of patients presenting with ACLF using Model for End-Stage Liver Disease (MELD) score predictability. Methodology: This was a descriptive case series, conducted at Sheikh Zayed Hospital, Lahore, Pakistan from January 31, 2018 to July 30, 2018. One hundred and eighty five patients who met the inclusion criteria were enrolled using 95% confidence level and 4% margin of error. Data was entered and analyzed with SPSS version 23.0. Numerical variables including age was presented by Mean ± S.D. Categorical variables i.e. gender, etiology of acute-on-chronic liver failure and 30-day mortality were presented by frequency and percentage. Data was stratified for age, gender, duration of chronic liver disease and MELD grade to address the effect modifiers. Post-stratification chi-square test was calculated using 95% significance (p?0.05). Results: Majority of the enrolled patients were male (74.6%) while only 25.4% of the patients were female. One hundred and thirty patients (70.3%) had underlying viral hepatitis while twelve patients (6.5%) and forty three patients (23.2%) presented with alcoholic liver disease and drug-induced ACLF, respectively. Eighty patients (43.2%) died within 30 days of admission.The 30-day mortality with respect to MELD grade was statistically significant (p<0.001) with the highest mortality noted in grade-IV and thirty five patients (43.8%) dying within 30 days of admission (p<0.001). Grade-II and III MELD scores also contributed to the 30-day mortality with twenty three patients (28.8%) and nineteen patients (23.8%) dying within 30 days of admission (p<0.001). Conclusion: MELD scores are able to accurately predict the short-term mortality in patients with ACLF and viral hepatitis was the most common etiology in our population. Early detection and use of appropriate prognostic models may alleviate mortality and morbidity in paitents with ACLF.

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Increased IL-17-producing CD8+ T cell frequency predicts short-term mortality in patients with hepatitis B virus-related acute-on-chronic liver failure

Therapeutics and Clinical Risk Management ◽

10.2147/tcrm.s184809 ◽

2018 ◽

Vol Volume 14 ◽

pp. 2127-2136 ◽

Cited By ~ 5

Author(s):

Geng-lin Zhang ◽

Ting Zhang ◽

Qi-yi Zhao ◽

Chan Xie ◽

Chao-shuang Lin ◽

...

Keyword(s):

Hepatitis B Virus ◽

Hepatitis B ◽

Liver Failure ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Short Term ◽

Cell Frequency ◽

B Virus ◽

Short Term Mortality

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Clinical Features of Hepatitis C Virus-Related Acute-On-Chronic Liver Failure in a Korean Population

10.21203/rs.3.rs-181706/v1 ◽

2021 ◽

Author(s):

Jung Woo Choi ◽

Jin-Kyu Cho ◽

Sang Soo Lee ◽

Jae Heon Kim ◽

Hankyu Jeon ◽

...

Keyword(s):

Hepatitis C Virus ◽

Hepatitis C ◽

Hepatitis B Virus ◽

Liver Failure ◽

Chronic Liver ◽

Chronic Liver Failure ◽

Short Term ◽

B Virus ◽

Short Term Mortality ◽

Very High

Abstract Background Acute-on-chronic liver failure (ACLF) is a widely recognized concept in which acute decompensation (AD) in patients with cirrhosis results in organ failures and high short-term mortality. However, few studies reflecting the various etiologies of cirrhosis are available. We aimed to investigate the clinical features of patients with hepatitis C virus (HCV)-related ACLF. Methods Between January 2005 and December 2018, 109 HCV-related cirrhosis patients who were hospitalized for AD (ascites, hepatic encephalopathy, gastrointestinal hemorrhage, and/or bacterial infection) were enrolled for ACLF defined by European Association for the Study of the Liver (EASL). Results ACLF developed in 35 patients (32.1%) on admission. Eight patients had ACLF grade 1, eight had ACLF grade 2, and 19 had ACLF grade 3. The 28-day and 90-day mortality rates were very low (2.7% and 5.4%, respectively) in patients without ACLF and very high (60.0% and 74.3%, respectively) in those with ACLF. In patients with HCV-related ACLF, the prevalence of liver failure was very low (17.1%), whereas that of kidney failure was very high (71.4%) compared to previous studies on hepatitis B virus-related ACLF and alcohol-related ACLF. Compared with all other prognostic scores, Chronic liver failure Consortium Organ Failure score most accurately predicted 90-day mortality, with an area under the receiver operator characteristic of 0.921. Conclusions HCV-related ACLF has unique clinical characteristics that are distinct from hepatitis B virus-related and alcohol-related ACLF. ACLF defined by EASL can be useful in predicting short-term mortality in HCV-related cirrhosis.

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