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

doi:10.4254/wjh.v16.i5.809

Advanced Search

BPG is committed to discovery and dissemination of knowledge

Home / Archive / Volume 16, Issue 5

This Article

Academic Content and Language Evaluation of This Article

CrossCheck and Google Search of This Article

Academic Rules and Norms of This Article

Citation of this article

Corresponding Author of This Article

Research Domain of This Article

Article-Type of This Article

Open-Access Policy of This Article

Times Cited Counts in Google of This Article

Number of Hits and Downloads for This Article

Total Article Views (2139)

All Articles published online

The chart showing PDF series, HTML series, Figures (1-3) series, Tables (1-3) series.

Item

Count

PDF

HTML

1577

Figures (1-3)

143

Tables (1-3)

126

Sum=1909

Publishing Process of This Article

The chart showing Browse series, Download series.

Item

Count

Browse

Download

142

Sum=169

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

Times Cited of This Article

Times Cited (0)

Journal Information of This Article

Publication Name

World Journal of Hepatology

ISSN

1948-5182

Publisher of This Article

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

Prospective Study

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

Table 1 Etiological characteristics of 3375 acute-on-chronic liver disease patients, n (%)

Characteristic	Overall (n = 3375)	Noncirrhosis (n = 792)	Cirrhosis (n = 2853)	P value
Demographics
Sex, male	2489 (73.7)	606 (76.5)	1883 (72.9)	0.048
Age, yr (mean ± SD)	49.65 ± 12.14	42.51 ± 11.65	51.84 ± 11.43	< 0.001
Etiology
HBV	2409 (71.4)	691 (87.2)	1718 (66.5)	< 0.001
HCV	126 (3.7)	11 (1.4)	115 (4.5)	< 0.001
ALD	649 (19.2)	100 (12.6)	549 (21.3)	< 0.001
AILD	308 (9.1)	39 (4.9)	269 (10.4)	< 0.001
MAFLD	104 (3.1)	69 (8.7)	35 (1.4)	< 0.001
DILD	58 (1.7)	25 (3.2)	33 (1.3)	0.001
MLD	7 (0.2)	2 (0.3)	5 (0.2)	1
Schistosomiasis	49 (1.5)	4 (0.5)	45 (1.7)	0.017
Cryptogenic	169 (5.0)	10 (1.3)	159 (6.2)	< 0.001

HBV: Hepatitis B virus; HCV: Hepatitis C virus; ALD: Alcohol-associated liver disease; MAFLD: Metabolic-associated fatty liver disease; DILD: Drug-induced liver disease; AILD: Autoimmune liver disease; MLD: Metabolic liver disease.

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.

Table 3 Characteristics of subtypes of acute-on-chronic liver failure, n (%)

Characteristic	Type A (n = 215)	Type B (n = 100)	Type C (n = 535)
Demographics
Sex, male	175 (81.4)	87 (87.0)	440 (82.2)
Age, yr [median (IQR)]	42.0 (34.0, 49.9)	46.9 (39.7, 54.2)^a	49.2 (43.0, 57.0)^b^,^c
Precipitating events
HBV reactivation	33 (15.3)	11 (11.0)	78 (14.6)
Bacterial infection	54 (25.1)	34 (34.0)	223 (41.7)^b
Alcohol intake	21 (9.77)	8 (8.00)	70 (13.1)
Superimposed hepatitis viruses	13 (6.05)	9 (9.00)	24 (4.49)
Portal vein thrombosis	0 (0.00)	2 (2.00)	4 (0.75)
Surgery	2 (0.93)	0 (0.00)	3 (0.56)
Drug use	29 (13.5)	6 (6.00)	59 (11.0)
Physiological exhaustion	19 (8.84)	7 (7.00)	30 (5.61)
Undefined	55 (25.6)	34 (34.0)	75 (14.0)^b^,^c
Complications
Hepatic encephalopathy
Non-overt HE	186 (86.5)	96 (96.0)	444 (83.0)
Grade I-II	20 (9.30)	3 (3.00)	71 (13.3)^b
Grade III-IV	9 (4.19)	1 (1.00)	20 (3.74)^b
Gastrointestinal bleeding	0 (0.00)	0 (0.00)	38 (7.10)^b^,^c
Ascites	69 (32.1)	10 (10.0)^a	436 (81.5)^b^,^c
Biochemical indicators [median (IQR)]
WBC (× 10⁹/L)	6.84 (5.27, 8.88)	6.23 (4.58, 8.67)	6.66 (4.64, 9.16)
HGB (g/L)	131 (118, 144)	126 (108, 136)^a	116 (98.0, 130)^b^,^c
PLT (× 10⁹/L)	121 (91.0, 154)	89.0 (62.0, 130)^a	80.0 (52.5, 116)^b^,^c
PT (s)	20.2 (2.35, 26.5)	22.5 (19.0, 27.6)^a	20.2 (2.52, 26.6)^b
INR	2.05 (1.72, 2.48)	2.08 (1.76, 2.50)	2.21 (1.81, 2.75)^c
ALT (IU/mL)	531 (200, 1131)	231 (90.7, 607)^a	133 (53.2, 388)^b^,^c
AST (IU/mL)	318 (170, 743)	230 (121, 482)^a	170 (91.0, 342)^b^,^c
AKP (IU/L)	152 (124, 198)	155 (120, 198)	146 (113, 186)
GGT (IU/L)	88.0 (57.0, 141)	82.0 (54.0, 132)	72.0 (43.0, 118)^c
TB (mg/dL)	19.2 (13.7, 25.8)	20.3 (14.2, 25.5)	20.7 (14.2, 28.5)^c
ALB (g/L)	32.1 (29.5, 35.2)	31.4 (28.4, 33.9)^a	29.9 (26.8, 33.1)^b^,^c
CRE (mg/L)	0.77 (0.61, 0.94)	0.75 (0.61, 0.94)	0.86 (0.68, 1.13)^b^,^c
BUN (mmol/L)	3.51 (2.87, 4.55)	3.92 (2.94, 6.05)^a	5.00 (3.65, 8.11)^b^,^c
Na (mmol/L)	137 (135, 140)	137 (133, 140)	136 (131, 138)^b^,^c
MELD score [median (IQR)]	19.9 (17.4, 24.1)	20.7 (17.9, 25.4)	22.6 (19.3, 26.8)^b^,^c
Mortality (LT free)
28-d	38 (17.7)	18 (18.0)	147 (27.5)^b^,^c
90-d	58 (27.0)	36 (36.0)	232 (43.4)^b^,^c

^aP < 0.05, type A vs type B acute-on-chronic liver failure (ACLF).

^bP < 0.05, type B vs type C ACLF.

^cP < 0.05, type A vs type C ACLF.

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