S3411 Profile of Anaemia in Patients With Acute-on-Chronic Liver Failure

Abstract

Introduction: Acute-on-chronic liver failure (ACLF) is a syndrome associated with a very high short term mortality. Patients with ACLF are often anaemic which may be multifactorial. We aim to characterise anaemia in patients with ACLF and to identify the role of Hepcidin and Ferritin in predicting mortality in anaemic patients with ACLF. Methods: Patients with ACLF as defined by the European association for study of liver (EASL) – chronic liver failure (CLIF) were screened for presence of anaemia. Anaemia was defined by a Haemoglobin of less than 13 g/dL in males and less than 12 g/dL in females. All patients were prospectively followed for 30 days. Red Blood cell indices, peripheral smear, iron profile, vitamin B12 and folate levels, retic count, coombs test, and lactate dehydrogenase were done to characterise anaemia. In addition, serum hepcidin levels were measured in a subset of patients. These parameters were compared among survivors and non-survivors. Anaemia was labelled to be due to hypersplenism when no other etiology was identified. Results: A total of 135 patients with ACLF were screened, out of which 94 patients had anaemia and were recruited for the study. The median (IQR) age of the cohort was 47.5 (38 – 57) years. Majority were males (n=84; 89.36%). The most common etiology of liver disease was alcohol, seen in 70.21%. Macrocytic anaemia was the most common finding seen on peripheral smear (n=21; 52.5%). Most common cause of anaemia in ACLF was haemolytic anaemia, seen in 31.91% patients while least common was vitamin B12/folate deficiency. Serum hepcidin was done in 40 patients. Although hepcidin was elevated in non-survivors, it did not reach statistical significance. Overall mortality was 58.51% at 30-days. Baseline characteristics among survivors and non-survivors are provided in Table. On multivariate logistic regression analysis, MELD-Na was the only predictor of mortality. Conclusion: Macrocytic anaemia is a common finding in patients with ACLF which is most often due to haemolysis. Measuring serum levels of vitamin B12 and folate is not accurate as most of the patients have previously received vitamin supplements leading to spuriously normal levels.Table 1.: * - Median (interquartile range); † - Mean ± Standard Deviation Abbreviations : MCV - Mean Corpuscular Volume, MCHC - Mean corpuscular hemoglobin concentration; RDW - red cell distribution width; INR - International normalised ratio; CRP - C-reactive protein; MELD-Na - Model for end stage liver disease-sodium; IDA - Iron deficiency anemia Table - Baseline characteristics among survivors and non-survivors.