scholarly journals Clinical profile and outcome among patients with acute-on-chronic liver failure admitted in the intensive care unit

2021 ◽  
Vol 33 (1) ◽  
Author(s):  
Marwa Lotfi El Sayed ◽  
Tarek El Sayed Gouda ◽  
E. L. Sayed Abdel Maksood Khalil ◽  
Mohammed Mohammed El Sayed Al Arman ◽  
Islam Eid Mohamed
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Failure ◽  
Prognostic Score ◽  
Mortality Rates ◽  
Chronic Liver ◽  
Clinical Profile ◽  
Chronic Liver Failure ◽  
Hepatic Decompensation ◽  
Significant Difference

Abstract Background Acute-on-chronic liver failure (ACLF) has been recently defined as a clinical form including acute hepatic decompensation and high 28-day mortality. ACLF usually follows a precipitating event on the background of established cirrhosis. ACLF is considered the most frequent indication for admission to the ICU among cirrhotic patients. Our research aimed to reveal the clinical profile and outcome among patients with ACLF to detect an allocation system of these patients to the intensive care unit (ICU), and a decision tool for clinical practice. It is a prospective study of 60 patients with ACLF. Patients are divided into group A that included 30 patients with ACLF admitted to the hepatology and gastroenterology ward and group B that also included 30 patients with ACLF admitted to the ICU. Each group is subdivided into subgroups regarding the grade of ACLF. Results The most common precipitating factor of ACLF is SBP 78.3% (80% in ICU, 73.6% inward). Renal failure is the most common organ failure in ACLF in both groups. CLIF-C ACLF is assumed to be a highly prognostic score for mortality in ACLF patients better than other scores. ROC curve of CLIF-C ACLF with AUC: 0.972 and CI: 0.919, 1.025 showed a cutoff point = 57.0 above which intensive care admission does not seem to benefit ACLF patients. The sensitivity at the optimal cut point is 88.89% and the specificity is 100%. There is a significant difference between the 3 ACLF groups regarding 1-month and 3-month mortalities in patients admitted to the ICU. ACLF1 shows the least 1-month and 3-month mortality rates while ACLF3 shows the highest mortality rates in ICU patients ((1-month mortality: 20%, 60%, 100% in ACLF1, 2, 3 respectively), (3-month mortality: 50%, 80%, 100% in ACLF1, 2, 3 respectively)). Conclusion Mortality is high in ACLF and increases with the number of organ failures (40% in ACLF1 to 100% in ACLF3). CLIFC-ACLF is the most prognostic scoring system with a cut-off value of 57; above this value, mortality is a fact.

scholarly journals The patient with cirrhosis in the intensive care unit and the management of acute-on-chronic liver failure

2020 ◽  
pp. 175114372097884
Author(s):  
Neha N Passi ◽  
Mark JW McPhail
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Failure ◽  
Clinical Syndrome ◽  
Chronic Liver ◽  
Chronic Liver Failure ◽  
Hepatic Decompensation ◽  
Starting Point ◽  
Improvement In Survival ◽  
Evidence Based Guidelines

Acute on chronic liver failure (ACLF) is a clinical syndrome characterised by acute hepatic decompensation, multi-organ failure and high mortality, in patients with cirrhosis.  Organ dysfunction in ACLF is often reversible and when necessary these patients should be considered appropriate candidates for admission to an intensive care unit (ICU). The yearly increase in numbers of patients with ACLF admitted to ICU has been matched with an improvement in survival.  ACLF has only been recently defined. In the absence of evidence-based guidelines we outline a systems-based approach to care which encompasses accepted ICU practice and evidence from trials in this cohort. We advocate for timely referral to specialist liver centres and consider the complexities of proceeding with liver transplantation. Equally, in a proportion of patients who continue to deteriorate, appropriate ceilings of care should be established.  Future clinical trials may change treatment paradigms but care of patients with ACLF is undoubtedly becoming an integral part of an intensivist’s practice. We hope that this review is a welcome starting point when managing this complex clinical syndrome.

scholarly journals The intensive care unit course and outcome in acute-on-chronic liver failure are comparable to other populations

2018 ◽  
Vol 69 (4) ◽  
pp. 803-809 ◽  
Author(s):  
Philippe Meersseman ◽  
Lies Langouche ◽  
Johannie du Plessis ◽  
Hannelie Korf ◽  
Michaël Mekeirele ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Failure ◽  
Chronic Liver ◽  
Chronic Liver Failure

scholarly journals Predictive factors for 28-day mortality in acute-on-chronic liver failure patients admitted to the intensive care unit

2019 ◽  
Vol 51 (10) ◽  
pp. 1416-1422 ◽  
Author(s):  
Amanda Pinter Carvalheiro da Silva Boteon ◽  
Abhishek Chauhan ◽  
Yuri Longatto Boteon ◽  
Suchintha Tillakaratne ◽  
Bridget Gunson ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Failure ◽  
Predictive Factors ◽  
Chronic Liver ◽  
Chronic Liver Failure

scholarly journals Comparison of General and Liver-Specific Prognostic Scores in Their Ability to Predict Mortality in Cirrhotic Patients Admitted to the Intensive Care Unit

2021 ◽  
Vol 2021 ◽  
pp. 1-13
Author(s):  
Pedro Paulo Costa e Silva ◽  
Liana Codes ◽  
Fernanda Ferreira Rios ◽  
Carolina Pedreira Esteve ◽  
Murilo Tavares Valverde Filho ◽  
...  
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Liver Failure ◽  
Organ Failure ◽  
Critically Ill ◽  
Chronic Liver ◽  
Apache Ii ◽  
Prognostic Scores ◽  
Chronic Liver Failure ◽  
Cirrhotic Patients

Introduction. Acute Physiology and Chronic Health Evaluation (APACHE) II and III and Sequential Organ Failure Assessment (SOFA) are prognostic scores commonly used in the intensive care unit (ICU). Their accuracy in predicting mortality has not been adequately evaluated in comparison to prognostic scores commonly used in critically ill cirrhotic patients with acute decompensation (AD) or acute-on-chronic liver failure (ACLF). Aims. This study was conducted to evaluate the performance of prognostic scores, including APACHE II, SOFA, Chronic Liver Failure Consortium (CLIF-C) SOFA, Child–Turcotte–Pugh (CPS), Model for End-Stage Liver Disease (MELD), MELD-Na, MELD to serum sodium ratio (MESO) index, CLIF-C organ failure (CLIF-C OF), CLIF-C ACLF, and CLIF-C AD scores, in predicting mortality of cirrhotic patients admitted to the ICU. Patients and Methods. A total of 382 patients (280 males, mean age 67.3 ± 10.6 years) with cirrhosis were retrospectively evaluated. All prognostic scores were calculated in the first 24 hours of ICU admission. Their ability to predict mortality was measured using the analysis of the area under the receiver operating characteristic curve (AUC). Results. Mortality was observed in 31% of the patients. Analysis of AUC revealed that CLIF-C OF (0.807) and CLIF-SOFA (0.776) had the best ability to predict mortality in all patients, but CLIF-C OF (0.749) had higher prognostic accuracy in patients with ACLF. CLIF-SOFA, SOFA, and CLIF-C AD had the highest AUC values in patients with AD, with no statistical difference ( p = 0.971 ). Conclusions. When compared to other general or liver-specific prognostic scores, CLIF-C OF, CLIF-SOFA, SOFA, and CLIF-C AD have good accuracy to predict mortality in critically ill patients with cirrhosis and patients with AD. According to the clinical scenario, different scores should be used to provide prognosis to patients with cirrhosis in the ICU.

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