Retrospective Cohort Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 14, 2016; 22(14): 3785-3792
Published online Apr 14, 2016. doi: 10.3748/wjg.v22.i14.3785
Characteristics and outcomes of chronic liver disease patients with acute deteriorated liver function by severity of underlying liver disease
Yun Soo Hong, Dong Hyun Sinn, Geum-Youn Gwak, Juhee Cho, Danbee Kang, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik
Yun Soo Hong, Dong Hyun Sinn, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea
Juhee Cho, Danbee Kang, Department of Health Sciences and Technology, SAIHST, Sungkyunkwan University, Seoul 06351, South Korea
Juhee Cho, Deaprtment of Health, Behavior and Society and Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MA 21205, United States
Author contributions: Sinn DH and Gwak GY designed this study; Hong YS, Cho J, Kang D statistical analysis; Hong YS, Sinn DH writing of the draft manuscript; Gwak GY, Paik YH, Choi MS, Lee JH, Koh KC and Paik SW collection data; Gwak GY, Paik YH, Choi MS, Lee JH, Koh KC and Paik SW critical revision of the manuscript; Hong YS and Sinn DH contributed equally to this work.
Institutional review board statement: The study was reviewed and approved by the Institutional review board at Samsung Medical Center.
Informed consent statement: Waived by the Institutional Review Board of Samsung Medical Center.
Conflict-of-interest statement: All the authors have no conflict of interest related to the manuscript.
Data sharing statement: The original anonymous dataset is available on request from the corresponding author at gy.gwak@samsung.com
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Geum-Youn Gwak, MD, PhD, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-Gu, Seoul 06351, South Korea. gy.gwak@samsung.com
Telephone: +82-2-34103409 Fax: +82-2-34106983
Received: December 10, 2015
Peer-review started: December 10, 2015
First decision: January 13, 2016
Revised: January 19, 2016
Accepted: February 20, 2016
Article in press: February 22, 2016
Published online: April 14, 2016
Processing time: 110 Days and 2.1 Hours
Abstract

AIM: To analyze characteristics and outcome of patients with acute-on-chronic liver failure (ACLF) according to the severity of underlying liver disease.

METHODS: One hundred and sixty-seven adult patients with chronic liver disease and acute deteriorated liver function, defined by jaundice and coagulopathy, were analyzed. Predisposition, type of injury, response, organ failure, and survival were analyzed and compared between patients with non-cirrhosis (type A), cirrhosis (type B) and cirrhosis with previous decompensation (type C).

RESULTS: The predisposition was mostly hepatitis B in type A, while it was alcoholic liver disease in types B and C. Injury was mostly hepatic in type A, but was non-hepatic in type C. Liver failure, defined by CLIF-SOFA, was more frequent in types A and B, and circulatory failure was more frequent in type C. The 30-d overall survival rate (85.3%, 81.1% and 83.7% for types A, B and C, respectively, P = 0.31) and the 30-d transplant-free survival rate (55.9%, 65.5% and 62.5% for types A, B and C, respectively P = 0.33) were not different by ACLF subtype, but 1-year overall survival rate were different (85.3%, 71.7% and 58.7% for types A, B and C, respectively, P = 0.02).

CONCLUSION: There were clear differences in predisposition, type of injury, accompanying organ failure and long-term mortality according to spectrum of chronic liver disease, implying classifying subtype according to the severity of underlying liver disease is useful for defining, clarifying and comparing ACLF.

Keywords: Acute-on chronic liver failure; Classification; Injury; Organ failure; Survival

Core tip: Controversy exists over defining acute on chronic liver failure (ACLF). Recently, multimodal ACLF classification that classifies patients into chronic hepatitis, cirrhosis and cirrhosis with previous decompensation has been suggested. We found that the new ACLF classification has clear differences in predisposition, type of injury, accompanying organ failure and long-term outcome by subtype. ACLF patients showed similar high short-term mortality, especially without liver transplantation, according to the subtype, but showed clear difference in the long-term mortality, indicating that the subtyping of ACLF by severity of underlying liver disease is useful.