A study on outcome of patients with acute-on-chronic liver failure at a tertiary care hospital

Abstract

Acute-on-chronic liver failure (ACLF) is relatively recent entity and is not well described in the literature. The term acute-on-chronic liver failure was first used in 1995 to describe a condition in which two insults to the liver are operating simultaneously, one of them being ongoing and chronic and the other one acute. However, a clear definition of ACLF is still lacking, and this term is being used to mean different entities by different clinicians. Any patient who had underlying chronic liver disease with superimposed acute insult is being labeled as having ACLF. Whatsoever may be the case the most important is the denominator, the presence or absence of underlying liver disease. Prospectively collected data of all patients included demographics, clinical presentation, course in hospital and outcome. All patients had routine hematological biochemical and liver function tests. The etiology of superimposed acute event and chronic liver disease was investigated in detail and prognostic scores were calculated within 24hrs of admission. 60 patients included in our study were followed up for next three months, of which 30 patients died and 30 patients survived. All patients were classified in Child- Pugh class based on CTP score. There were only three patients Child-Pugh class A and none of them died. Child- Pugh class B had 10 patients, out of these 2 patients died & 8 patients survived. Total 47 patients were classified in Child-Pugh class C and 28 (59.57%) & this difference was statistically significant (p=0.013). According EASL-CLIF consortium grading, 23 out of 30 patients of Grade 3 ACLF, 5 out of 16 Grade 2 ACLF, 2 out of 11 Grade 1 ACLF & none of the Grade 0 ACLF patients died. These findings are statistically very much significant (P=0.0001). Even MELD score was significantly high among Non survivors when compared to the Survivors. (30.04 ± 2.37 Vs 25.53 ± 1.81) (p=0.0001).