Characterization of acute-on-chronic liver diseases: A multicenter prospective cohort study

doi:10.4254/wjh.v16.i5.809

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May 27, 2024 (publication date) through Aug 25, 2024

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World Journal of Hepatology

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1948-5182

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

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World J Hepatol. May 27, 2024; 16(5): 809-821
Published online May 27, 2024. doi: 10.4254/wjh.v16.i5.809

Table 2 Clinical characteristics of acute-on-chronic liver disease patients, n (%)

Characteristic	Overall (n = 3375)	ACLF (n = 850)	non-ACLF
Characteristic	Overall (n = 3375)	ACLF (n = 850)	Overall (n = 2525)	CHAE (n = 577)	LC-A (n = 269)	LC-AD (n = 1679)
Demographics
Sex, male	2489 (73.7)	702 (82.6)	1787 (70.8)^a	431 (74.7)	174 (64.7)^b	1182 (70.4)
Age, yr [median (IQR)]	49.3 (41.6, 58.5)	47.5 (40.0, 55.1)	51.0 (42.7, 59.8)^a	42.2 (33.0, 50.0)	50.2 (43.8, 56.3)^b	53.0 (45.5, 61.4)^c^,^d
Precipitating events
Bacterial infection	771 (22.8)	311 (36.6)	460 (18.2)^a	31 (5.4)	41 (15.2)^b	388 (23.1)^c^,^d
HBV reactivation	378 (11.2)	122 (14.4)	256 (10.1)^a	149 (25.8)	25 (9.29)^b	82 (4.9)^c^,^d
Alcohol intake	327 (9.7)	99 (11.6)	228 (9.0)^a	45 (7.8)	22 (8.18)	161 (9.6)
Superimposed hepatitis viruses	94 (2.8)	46 (5.4)	48 (1.9)^a	18 (3.1)	1 (0.37)	29 (1.7)
Portal vein thrombosis	66 (2.0)	6 (0.7)	60 (2.4)^a	0 (0.0)	1 (0.37)	59 (3.5)^c^,^d
Surgery	40 (1.2)	5 (0.6)	35 (1.4)	1 (0.2)	2 (0.74)	32 (1.9)^d
Drug use	230 (6.8)	94 (11.1)	136 (5.4)^a	55 (9.5)	12 (4.46)	69 (4.1)^d
Physiological exhaustion	138 (4.1)	56 (6.6)	82 (3.3)^a	28 (4.9)	10 (3.72)	44 (2.6)^d
Undefined	925 (27.4)	164 (19.3)	761 (30.1)^a	181 (31.4)	86 (32.0)	494 (29.4)
Complications
HE
Non-overt HE	3080 (91.3)	726 (85.4)	2354 (93.2)	570 (98.8)	265 (98.5)	1519 (90.5)
Grade I-II	233 (6.90)	94 (11.1)	139 (5.50)^a	7 (1.21)	3 (1.12)^b	129 (7.68)^c^,^d
Grade III-IV	62 (1.84)	30 (3.53)	32 (1.27)^a	0 (0.00)	1 (0.37)^b	31 (1.85)^c^,^d
Gastrointestinal bleeding	520 (15.4)	38 (4.47)	482 (19.1)^a	0 (0.00)	0 (0.00)	482 (28.7)^c^,^d
Ascites	1662 (49.2)	515 (60.6)	1147 (45.4)^a	24 (4.16)	6 (2.23)	1117 (66.5)^c^,^d
Biochemical indicators, [median (IQR)]
WBC (× 10⁹/L)	4.91 (3.57, 6.90)	6.61 (4.75, 9.01)	4.49 (3.23, 6.12)^a	4.90 (4.08, 6.09)	4.09 (3.11, 5.48)^b	4.35 (2.95, 6.26)^c^,^d
HGB (g/L)	117 (95.0, 135)	120 (104, 135)	116 (92.0, 135)^a	140 (130, 153)	122 (108, 137)^b	104 (83.0, 122)^c^,^d
PLT (×10⁹/L)	89.0 (56.0, 137)	91.0 (62.0, 129)	89.0 (55.0, 140)	143 (114, 179)	85.0 (59.8, 132)^b	72.0 (48.0, 111)^c^,^d
PT (s)	13.9 (1.69, 18.4)	20.6 (2.57, 26.8)	13.2 (1.45, 16.3)^a	11.8 (1.29, 14.4)	1.90 (1.21, 14.8)	14.2 (1.58, 17.0)^c^,^d
INR	1.44 (1.21, 1.82)	2.13 (1.77, 2.65)	1.32 (1.15, 1.52)^a	1.17 (1.05, 1.34)	1.23 (1.10, 1.46)^b	1.38 (1.22, 1.59)^c^,^d
ALT (IU/mL)	89.0 (32.0, 448)	209 (73.7, 611)	62.3 (27.0, 359)^a	723 (416, 1137)	89.6 (39.8, 252)^b	38.2 (22.4, 80.4)^c^,^d
AST (IU/mL)	114 (47.1, 313)	198 (105, 451)	84.0 (39.2, 258)^a	432 (256, 748)	102 (51.8, 212)^b	54.0 (31.0, 106)^c^,^d
AKP (IU/L)	127 (92.0, 172)	148 (117, 190)	119 (84.7, 164)^a	130 (103, 168)	127 (92.0, 168)	112 (77.0, 161)^c^,^d
GGT (IU/L)	78.8 (38.0, 152)	78.0 (48.6, 127)	79.0 (33.8, 161)^a	151 (97.3, 231)	106 (41.0, 190)^b	54.3 (25.0, 117)^c^,^d
TB (mg/dL)	4.33 (1.68, 13.7)	20.1 (14.1, 27.4)	2.53 (1.33, 5.96)	3.37 (1.71, 8.38)	2.17 (1.34, 3.34)^b	2.44 (1.23, 5.85)^c^,^d
ALB (g/L)	31.7 (27.5, 36.0)	30.7 (27.3, 33.8)	32.1 (27.6, 36.8)^a	38.2 (34.1, 41.5)	33.5 (29.0, 37.4)^b	30.2 (26.3, 34.0)^c^,^d
CRE (mg/L)	0.77 (0.64, 0.94)	0.81 (0.65, 1.08)	0.76 (0.64, 0.91)^a	0.76 (0.64, 0.86)	0.75 (0.61, 0.92)	0.77 (0.64, 0.93)^d
BUN (mmol/L)	4.60 (3.50, 6.60)	4.40 (3.28, 6.60)	4.68 (3.60, 6.60)^a	3.90 (3.12, 4.70)	4.39 (3.70, 5.47)^b	5.30 (3.85, 7.51)^c^,^d
Na (mmol/L)	138 (135, 141)	136 (133, 139)	139 (136, 141)^a	139 (137, 141)	140 (137, 142)	138 (136, 141)^c^,^d
MELD score [median (IQR)]	11.5 (5.92, 18.2)	21.9 (18.5, 25.9)	8.75 (4.60, 13.0)^a	7.79 (3.81, 12.1)	6.56 (3.55, 9.58)^b	9.50 (5.09, 13.7)^c^,^d
Mortality (LT free)
28-d	278 (8.24)	203 (23.9)	75 (2.97)^a	1 (0.17)	2 (0.74)	72 (4.29)^c^,^d
90-d	492 (14.6)	326 (38.4)	166 (6.57)^a	7 (1.21)	8 (2.97)	151 (8.99)^c^,^d

^aP < 0.05 acute-on-chronic liver failure (ACLF) vs non-ACLF.

^bP < 0.05 chronic hepatitis with acute exacerbation (CHAE) vs liver cirrhosis active phase (LC-A).

^cP < 0.05 LC-A vs liver cirrhosis acute decompensation (LC-AD).

^dP < 0.05 CHAE vs LC-AD.

AoCLD: Acute-on-chronic liver disease; CHAE: Chronic hepatitis with acute exacerbation; LC-A: Liver cirrhosis active phase; LC-AD: Liver cirrhosis acute decompensation; ACLF: Acute-on-chronic liver failure; ALD: Alcohol-associated liver disease; MAFLD: Metabolic-associated fatty liver disease; DILI: Drug-induced liver injury; AILD: Autoimmune liver disease; MLD: Metabolic liver disease. LT: Liver transplantation; HE: Hepatic encephalopathy; IQR: Interquartile ranges; HGB: Hemoglobin; PLT: Platelet; PT: Prothrombin time; INR: International normalized ratio; ALT: Alanine aminotransferase; AST: Aspartate aminotransferase; AKP: Anterior Knee Pain; TB: Total bilirubin; ALB: Albumin; CRE: Creatinine; BUN: Blood urea nitrogen; MELD: Model for end-stage liver disease; WBC: White blood cell; GGT: γ-glutamyl transferase.

Citation: Zhang YY, Luo S, Li H, Sun SN, Wang XB, Zheng X, Huang Y, Li BL, Gao YH, Qian ZP, Liu F, Lu XB, Liu JP, Ren HT, Zheng YB, Yan HD, Deng GH, Qiao L, Zhang Y, Gu WY, Xiang XM, Zhou Y, Hou YX, Zhang Q, Xiong Y, Zou CC, Chen J, Huang ZB, Jiang XH, Qi TT, Chen YY, Gao N, Liu CY, Yuan W, Mei X, Li J, Li T, Zheng RJ, Zhou XY, Zhao J, Meng ZJ. Characterization of acute-on-chronic liver diseases: A multicenter prospective cohort study. World J Hepatol 2024; 16(5): 809-821
URL: https://www.wjgnet.com/1948-5182/full/v16/i5/809.htm
DOI: https://dx.doi.org/10.4254/wjh.v16.i5.809