Abstract
Background & AimTo investigate the prevalence, mortalities, and patient characteristics of Acute-on-chronic liver failure (ACLF) according to the AARC (Asian Pacific Association for the Study of the Liver ACLF Research Consortium) and European Association for the Study of the Liver CLIF-C (Chronic Liver Failure Consortium) definitions.MethodsWe collected retrospective data for 1470 hospitalized patients with chronic liver disease (CLD) and acute deterioration between January 2013 and December 2013 from 21 university hospitals in Korea.ResultsOf the patients assessed, the prevalence of ACLF based on the AARC and CLIF-C definitions was 9.5% and 18.6%, respectively. The 28-day and 90-day mortality rates were higher in patients with ACLF than in those without ACLF. Patients who only met the CLIF-C definition had significantly lower 28-day and 90-day survival rates than those who only met the AARC definition (68.0% vs. 93.9%, P<0.001; 55.1% vs. 92.4%, P<0.001). Among the patients who had non-cirrhotic CLD, the 90-day mortality of the patients with ACLF was higher than of those without ACLF, although not significant (33.3% vs. 6.0%, P = 0.192). Patients with previous acute decompensation (AD) within 1- year had a lower 90-day survival rate than those with AD more than 1 year prior or without previous AD (81.0% vs. 91.9% or 89.4%, respectively, all P<0.001). Patients who had extra-hepatic organ failure without liver failure had a similar 90-day survival rate to those who had liver failure as a prerequisite (57.0% vs. 60.6%, P = 0.391).ConclusionsThe two ACLF definitions result in differences in mortality and patient characteristics among ACLF patients. We suggest that non-cirrhotic CLD, previous AD within 1 year, and extra-hepatic organ failure should be included in the ACLF diagnostic criteria. In addition, further studies are necessary to develop a universal definition of ACLF.
Highlights
Cirrhosis is often clinically silent until decompensation occurs
The prevalence of acute-on-chronic liver failure (ACLF) based on the AARC and CLIF-C definitions was 9.5% and 18.6%, respectively
The two ACLF definitions result in differences in mortality and patient characteristics among ACLF patients
Summary
Cirrhosis is often clinically silent until decompensation occurs. Once a patient progresses to the decompensated phase, complications tend to accumulate and survival is markedly reduced. Episodes of acute deterioration due to acute insults are common causes of hospitalization among patients with chronic liver disease (CLD). The concept of acute-on-chronic liver failure (ACLF) has emerged to identify those patients with CLD or cirrhosis who exhibit acute deterioration of liver function[1]. These patients are characterized by a short-term mortality rate higher than that expected for decompensated cirrhosis, with rapid progression to other end organ failure[2]. Mortalities, and patient characteristics of Acute-on-chronic liver failure (ACLF) according to the AARC
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