Published online Dec 8, 2016. doi: 10.4254/wjh.v8.i34.1529
Peer-review started: July 14, 2016
First decision: August 22, 2016
Revised: September 20, 2016
Accepted: October 17, 2016
Article in press: October 18, 2016
Published online: December 8, 2016
To study the prevalence, characteristics, risk factors and mortality at 28 d of acute-on-chronic liver failure (ACLF).
A total of 100 cirrhotic patients admitted to our hospital for more than one day were included during the period between June 2013 and December 2015. We used the European Association for the Study of the Liver-Chronic Liver Failure-Consortium diagnostic criteria for ACLF, considering it as the acute decompensation of cirrhosis associated with the presence of one or more organ failure. For the diagnosis of organic failure the Chronic Liver Failure-Sequential Organ Failure Assessment score was used. Our population was divided into patients with and without ACLF. Clinical characteristics, presence of precipitating events, potential risk factors for developing ACLF and causes of mortality were analyzed. Mortality at 28 d was evaluated.
Twenty-nine patients (29%) developed ACLF criteria. Alcoholism, detected in 58 patients (58%), was the major etiological agent of cirrhosis. Bacterial infections were recognized as a precipitating event in 41.3% of cases and gastrointestinal bleeding in 27.5%. No precipitating event was identifiable in 27.5% of patients with ACLF. Comparing patients with and without ACLF, statistically significant risk factors were: Child Pugh score 10.2 ± 2.1 vs 8.4 ± 1.6 (P ˂ 0.0001), MELD score 20.7 ± 8.5 vs 12.3 ± 4 (P ˂ 0.0001), presence of ascites 27 (93%) vs 43 (60.5%) (P = 0.001), leukocytosis 15300 ± 8033 per cubic millimeter vs 10770 ± 5601 per cubic millimeter (P ˂ 0.0001), and high plasma levels of C reactive protein values 50.9 ± 46.4 mg/L vs 28.6 ± 23.4 mg/L (P ˂ 0.0019). Mortality rate was 62% (18 patients) vs 5.6% (4 patients), respectively (P < 0.0001).
We observed that the ACLF is a frequent entity in this group of patients and has a significantly higher mortality rate.
Core tip: Acute-on-chronic liver failure (ACLF) is an increasingly recognized entity that is gaining acceptance in recent times. It is characterized by an acute impairment of an underlying chronic liver disease with high short-term mortality, produced by the development of organic failures and associated with precipitating event. However, little is known about the development and progression of this syndrome. Guided by the European Association for the Study of the Liver-Chronic Liver Failure-Consortium diagnostic criteria and the CANONIC study, we could establish that the prevalence of ACLF in our center was 29%, and that Child Pugh advanced stage, MELD score, presence of ascites and inflammation parameters were significant risk factors for ACLF.