Published online Jun 16, 2023. doi: 10.12998/wjcc.v11.i17.4003
Peer-review started: March 22, 2023
First decision: April 11, 2023
Revised: April 15, 2023
Accepted: May 12, 2023
Article in press: May 12, 2023
Published online: June 16, 2023
Processing time: 82 Days and 6.2 Hours
Acute-on-chronic liver failure (ACLF) is a severe syndrome affecting patients with liver disease, characterized by decompensation, organ failure, and high mortality rates. ACLF diagnosis is based on clinical criteria, while treatment options remain limited, underscoring the need for predictive tools and targeted therapies to improve outcomes. This study aimed to identify prognostic factors and therapeutic targets associated with ACLF and acute variceal hemorrhage (AEVH) to improve patient management. The mechanisms of ACLF remain unclear, highlighting the importance of further research in this area.
The study on ACLF and AEVH aims to identify predictors of poor outcomes in AEVH and the development of ACLF, which has gained significant attention due to poor prognosis and limited treatment options. Understanding the pathophysiology and clinical implications of ACLF remains crucial, and identifying risk factors for its development could enhance our knowledge of this condition and inform future therapies. The study thus has important clinical implications for managing patients with liver disease.
The main objective of the study on ACLF and AEVH was to identify risk factors for mortality and to evaluate the role of non-selective beta-blockers (NSBB) in improving patient outcomes.
The study analyzed data of cirrhosis patients who received terlipressin for AEVH from 2010 to 2016. Patients with incomplete medical records or without cirrhosis were excluded. Extensive clinical and laboratory data was collected for each patient, and liver-specific scores were calculated. AEVH therapy involved terlipressin, prophylactic antibiotics, and lactulose. Outcomes were recorded as all-cause deaths, collected from medical records or national death databases.
This study provides insights into the prognosis of AEVH and ACLF. The study found that the all-cause mortality rate for AEVH ranged from 36% to 49.4% depending on the time point, while the prevalence of ACLF was 41.3%, with a higher mortality rate ranging from 57.1% to 100%. Various factors were associated with higher mortality rates, including etiology of cirrhosis, laboratory abnormalities, and scoring systems. The study emphasizes the importance of early identification and treatment of AEVH and ACLF, with previous use of NSBB being protective and MELD score and ACLF grade associated with higher mortality rates.
The study aimed to assess the utility of ACLF criteria for predicting AEVH prognosis. Patients with ACLF and AEVH had a high 30-day mortality rate of 67.5%. CLIF-SOFA and MELD scores were better predictors of hospital mortality and 6-week post-EVB mortality than other scores. Higher CTP and MELD scores were associated with higher 90-day and 30- and 90-day mortality rates, respectively. The previous use of NSBB was associated with lower 30- and 90-day mortality.
Future research on AEVH and ACLF should investigate long-term outcomes, including factors associated with better outcomes and novel therapeutic approaches. Developing new biomarkers for early detection and diagnosis is necessary, as current methods are limited in accuracy and specificity. Further research is needed to understand the underlying mechanisms of these conditions, particularly inflammation and immune dysregulation. Randomized controlled trials evaluating the efficacy and safety of various treatments, including pharmacological and non-pharmacological approaches, are necessary to manage AEVH and ACLF and improve patient outcomes.