Chronic Liver Failure Patients Research Articles

Accuracy of chronic liver failure consortium (CLIF-C) ACLF score compared with meld, MELD-NA and CTP as a mortality predictor in acute on chronic liver failure patients admitted to tertiary rural care hospital

Background Chronic Liver Failure Consortium (CLIF-C) ACLF score, Model for End-Stage Liver Disease (MELD), MELD-Na, and Child-Pugh (CTP) are established scoring systems for predicting mortality in Acute on Chronic Liver Failure (ACLF) patients. However, their comparative accuracy, especially in rural care settings, still needs to be explored. This study aims to assess and compare the predictive performance of these scoring systems, providing a nuanced understanding of their applicability in a tertiary rural care hospital. Method This prospective observational cohort study will be conducted at Acharya Vinoba Bhave Rural Hospital, following approval from the institutional ethical committee. ACLF patients aged 18 and above, presenting within one week of onset, will be included. Data collection will involve comprehensive assessments, including scoring system calculations, clinical examinations, and relevant investigations. Statistical analyses, encompassing descriptive statistics, comparative analyses, survival analyses, and multivariate models, will elucidate the accuracy and independent predictors of 28-day mortality. Expected Outcome Anticipated outcomes include a comprehensive understanding of the strengths and limitations of the CLIF-C ACLF score, MELD, MELD-Na, and CTP in predicting mortality among ACLF patients in a rural care context. The study aims to identify potential correlations and independent predictors, offering valuable insights for risk stratification. These findings are expected to guide clinicians in optimising prognostic assessments and decision-making, thereby improving the care and outcomes of ACLF patients in rural healthcare settings.

S1426 Simplified Prognostic Model for Predicting First 15 Days Mortality in Alcoholic Acute on Chronic Liver Failure Patients

S1426 Simplified Prognostic Model for Predicting First 15 Days Mortality in Alcoholic Acute on Chronic Liver Failure Patients

Living donor liver transplant in acute on chronic liver failure grade 3: Who not to transplant

Background and AimLiver transplantation(LT)offers definitive treatment for acute on chronic liver failure(ACLF) patients. This study was done to analyze and compare the outcomes of living donor LT(LDLT) in patients with ACLF versus Chronic liver disease(CLD) and within the grades of ACLF. Factors affecting mortality in patients with ACLF and ACLF grade3 (ACLF3) following LDLT were also derived. MethodsRecords of adult LDLT between 1/2/2017 and 30/9/2021 were analyzed. ACLF was classified based on EASL-CLIF definition. Post-transplant outcomes of ACLF were compared with CLD and within ACLF grades. Post LDLT mortality predictors were identified in ACLF and ACLF3 patients. ResultsOut of 853 patients who had LT in that period; 704 patients with CLD and 103 with ACLF [of which 54 (52.42%) had ACLF3] underwent LDLT. The one month and one-year post LDLT mortality was 8.81% and 9.80% in CLD; 19.42% and 31.06% in ACLF; and 25.92% and 38.89% in ACLF3 respectively. On log regression analysis, use of grafts from older donors and pre-operative respiratory failure in recipients was associated with poor survival in ACLF, while respiratory failure was a predictor of poor survival in ACLF3 following LDLT. ConclusionOutcomes following LDLT are poorer in ACLF as compared to after CLD. Higher donor age and preoperative respiratory failure with PF Ratio<200 were associated with poor survival post LDLT in ACLF and ACLF3.

OS-014-YI - Longitudinal change in the plasma metabotype indicates therapeutic plasma exchange in acute-on chronic liver failure patients should be done every 12 hours

OS-014-YI - Longitudinal change in the plasma metabotype indicates therapeutic plasma exchange in acute-on chronic liver failure patients should be done every 12 hours

Role of Non-Hepatotropic Viruses in Acute Sporadic Viral Hepatitis and Acute-on-Chronic Liver Failure in Adults

Background and Aim: Viral infections, drugs, metabolic disorders, and autoimmune processes can cause hepatitis, which is a diffuse inflammatory condition of the liver. Hepatitis E (HEV) and hepatitis A (HAV) viruses are the most common causes of acute viral hepatitis (AVH). AVH and chronic liver failure (ACLF) patients were studied to determine whether they were infected with various hepatotropic and non-hepatotropic viruses. Patients and Methods: This prospective study was conducted on 186 adult patients with ACLF and AVH in the Department of Gastroenterology, DHQ Teaching Hospital and Mufti Mahmood Memorial Hospital, Dera Ismail Khan from September 2020 to August 2022. Our study included consecutive patients with acute viral hepatitis who had a definite viral etiology, a fever or jaundice that developed after 3 weeks, and an ALT that was 2x the upper limit of normal. There were three serological tests performed for all the patients: hepatitis (A, B, C, D, and E), Epstein-Barr virus (EBV), and non-hepatitis (CMV). Data analysis was carried out in SPSS version 26. Results: Of the total 186 samples investigated, the incidence of ACLF and AVH was 60 (32.3%) and 126 (67.7%) respectively. The prevalence of confirmed etiology such as HEV, HAV, HBV, and HCV was 98 (52.7%), 29 (15.6%), 20 (10.8%), and 2 (1.1%) respectively. The mixed viral etiology and Epstein-Barr virus was present in 18 (9.7%) and 19 (10.2%) respectively. The most prevalent cause of infection was HEV found in 76 (60.3%) AVH and 42 (70%) ACLF cases. The mortality rate among AVH patients was significantly lower 2.4% (n=3) than ACLF 23.3% (n=14). As compared to ACLF patients, AVH patients had significantly higher infections caused by non-hepatotropic viruses (24 vs. 3, p=0.001). There were significantly more mixed infections in AVH as opposed to ACLF (28 vs. 4, p&lt;0.001). Conclusion: The present study concluded that both AVH and ACLF patients were susceptible to HEV-associated hepatitis. There were significant numbers of patients with AVH being infected with non-hepatotropic viruses including CMV and EBV. These viruses are much less common in patients with ACLF. Keywords: Epidemiology, Non-hepatotropic virus, Acute viral hepatitis, Acute chronic liver failure

Midodrine versus Albumin to Prevent Paracentesis Induced Circulatory Dysfunction in Acute on Chronic Liver Failure Patients in the Outpatient Clinic–a Randomized Controlled Trial

Paracentesis-induced circulatory disturbance (PICD) occurs in 12-20% of patients receiving human albumin for large-volume paracentesis, and can occur at lower than five liter paracentesis in acute-on-chronic liver failure (ACLF). Albumin infusions are associated with higher costs and more prolonged daycare admissions. The aim of the study was to determine if oral midodrine-hydrochloride can prevent PICD in these patients by increasing the mean arterial pressure (MAP). This open-labeled randomized controlled trial included ACLF patients undergoing paracentesis between 3 and 5L, who were randomized to receive either 20% human albumin or midodrine hydrochloride 7.5mg thrice daily for three days, 2h before paracentesis. MAP was recorded daily. The primary outcome was the plasma renin activity (PRA) on day six, and a 50% increase from baseline was considered PICD. 183 consecutive patients of ACLF were screened, and 50 patients were randomized to either arms. Alcohol was the most common underlying cause of cirrhosis. On day 6, PRA was non-significantly (P=0.056) higher in the midodrine group. The absolute change of PRA between the two groups was not significant (P= 0.093). Four (16%) patients in the albumin group and five (20%) in the midodrine group developed PICD. MAP increase was not different between the albumin and midodrine arms (P= 0.851). Midodrine was found to be more cost-effective. Three days of oral midodrine is as effective as a human-albumin infusion in preventing PICD in ACLF patients undergoing paracentesis lesser than that done in large volume paracentesis.

Simplified Prognostic Model for Predicting the First 15 Days Mortality in Alcoholic Acute On Chronic Liver Failure (ACLF) Patients

Simplified Prognostic Model for Predicting the First 15 Days Mortality in Alcoholic Acute On Chronic Liver Failure (ACLF) Patients

Profile of Acute On Chronic Liver Failure (ACLF) Patients Admitted In The Tertiary Care Hospital

Profile of Acute On Chronic Liver Failure (ACLF) Patients Admitted In The Tertiary Care Hospital

Effect of slow albumin, furosemide, and vasoconstrictors therapy (SAFIT) on endotoxins, cytokine levels, and survival in Acute on chronic liver failure (ACLF) patients with ascites and acute kidney injury: A comparative analysis with standard medical therapy

Effect of slow albumin, furosemide, and vasoconstrictors therapy (SAFIT) on endotoxins, cytokine levels, and survival in Acute on chronic liver failure (ACLF) patients with ascites and acute kidney injury: A comparative analysis with standard medical therapy

Therapeutic plasma exchange is a safe and effective bridge therapy in patients with alcohol-associated ACLF not having immediate prospects for liver transplantation-A case-control, pilot study.

Therapeutic plasma exchange (TPE) is a well-established treatment modality in acute liver failure patients, but its efficacy in treating acute on chronic liver failure (ACLF) patients is yet to be established. To assess the efficacy and safety of TPE in patients with alcohol-associated ACLF who were nonresponders to standard medical treatment (SMT) and without immediate prospects for liver transplantation. Twenty-eight alcohol-related ACLF (grade II) patients (14 cases and 14 controls) were enrolled in the study. Cases underwent standard volume TPE along with SMT while the controls were on SMT alone. The change (baseline to day 10) in laboratory parameters, cytokine concentrations, clinical severity scores along with 30 and 90 day mortality rates were noted and compared between the two groups. The adverse events (AEs) were noted in the groups and analyzed. A total of 51 TPE procedures were performed in 14 patients (average of 3.62 procedures/patient). TPE was effective in reduction of serum bilirubin, ammonia, activated partial thromboplastin time, prothrombin time, international normalized ratio, and severity scores (ACLF Research Consortium, Maddrey's discriminant function, and model for end-stage liver disease) (P < .05). There was no significant difference in the reduction of serum interleukin-6 (IL-6), IL-10, and tumor necrosis factor-α concentrations among cases. Among the cases who received the complete TPE interventions, 30- and 90-day mortality rates were lower in the cases as compared to controls albeit only the 90-day mortality was significantly different. Procedure-related AEs was observed in 2% of procedures. TPE is an effective and well-tolerated bridge therapy in patients with alcohol-associated ACLF of moderate severity not improving on SMT and without immediate prospects for liver transplantation.

Relationship between liver dysfunction, lipoprotein concentration and mortality during sepsis.

High-density lipoproteins (HDLs) are synthesized by the liver and display endothelioprotective properties, including anti-inflammatory, antiapoptotic, antithrombotic and antioxidant effects. In both septic and chronic liver failure patients, a low HDL cholesterol (HDL-C) concentration is associated with overmortality. Whereas sepsis-associated liver dysfunction is poorly defined, the aim of this study was to characterize the relationship between liver dysfunction, lipoprotein concentrations and mortality in septic patients in the intensive care unit (ICU). A prospective observational study was conducted in a university hospital ICU. All consecutive patients admitted for septic shock or sepsis were included. Total cholesterol, HDL-C, low-density lipoprotein-cholesterol (LDL-C), and triglyceride levels were assessed at admission. Sepsis-associated liver dysfunction was defined as a serum bilirubin≥ 2N or aspartate aminotransferase/alanine aminotransferase concentrations ≥ 2N. Short-term and one-year prognostic outcomes were prospectively assessed. A total of 219 septic patients were included, and 15% of them presented with sepsis-associated liver dysfunction at admission. Low concentrations of lipoproteins were associated with mortality at Day 28 in the overall population. Sepsis-associated liver dysfunction at admission was associated with overmortality. In this subgroup, patients had a lower HDL-C concentration than patients without hepatic dysfunction (HDL-C = 0.31 [0.25, 0.55] mmol/L vs. 0.48 [0.29, 0.73] mmol/L, p = 0.0079) but there was no relationship with the outcome. Interestingly, no correlation was observed between lipoprotein concentrations and liver dysfunction markers. Sepsis-associated liver dysfunction at ICU admission is strongly associated with overmortality and is associated with a lower HDL-C concentration. However, in this subgroup of patients, HDL-C concentration had no relationship with mortality. Further exploratory studies are needed to better understand the interaction between lipoproteins and liver dysfunction during sepsis.

A STUDY OF HAEMATOLOGICAL ABNORMALITIES IN CHRONIC LIVER DISEASE IN AJMER REGION

Chronic liver disease refers to a disease of the liver, which had lasted more than six months. The disease process involves progressive destruction and regeneration of liver parenchyma leading to brosis and cirrhosis. This study evaluates the various hematological indices as these parameters are part of an inexpensive, easily accessible, and routinely performed test for almost all patients admitted to health facilities to nd out a correlation between variation in hematological parameters and the illness under study. This study is conducted in the department of Pathology J.L.N Medical College and Associated group of hospitals, Ajmer (Rajasthan) prospectively from July 2019 to June 2020 (one year). In our study, the mean age for chronic liver disease was 44.48±11.84 years and the highest incidence was seen between the age group of 41-50 years (4th decade). M: F ratio was 6:1. Alcohol has been implicated as the most common cause. In the case of non- alcoholic hepatitis B has been implicated as the most common cause. The most common anemia is normocytic normochromic anemia. Microcytic anemia is most common among women. Macrocytosis is almost common with alcoholics. The mean MCV, MCH and MCHC were signicantly higher in alcoholic chronic liver disease patients. Thrombocytopenia is present in more than 30% of patients. In chronic liver failure patients, most of them had abnormalities in hematological parameters. Hence with this study, all the chronic liver disease patients must be evaluated for hematological and should be monitored for any complications. Early treatment to correct these comorbidities can decrease mortality.

Metabolic Risk Factors Are Associated with the Disease Severity and Prognosis of Hepatitis B Virus-Related Acute on Chronic Liver Failure.

Background/AimsMetabolic risk factors could accelerate hepatitis B virus (HBV)-related mortality; however, their impacts on disease severity in HBV-related acute on chronic liver failure (HBV-ACLF) patients remain unexplored. In this study, we assessed the effects of metabolic risk factors on the outcome of HBV-ACLF patients.MethodsThis study retrospectively enrolled antiviral therapy naïve HBV-ACLF patients from a single center in China. Patients were evaluated according to Child-Turcotte-Pugh score, Model for End-Stage Liver Disease (MELD) score, 30-day, 90-day mortality and survival rate to estimate the prognosis of HBV-ACLF. The impacts of different metabolic risk factors were further analyzed.ResultsA total of 233 patients, including 158 (67.8%) with metabolic risk factors and 75 (32.2%) without metabolic risk factors, were finally analyzed. Patients with metabolic risk factors had significantly higher MELD score (22.6±6.1 vs 19.8±3.8, p<0.001), 90-day mortality rate (56.3% vs 38.7%, p=0.017), and shorter median survival time (58 days vs 75 days hazard ratio, 1.553; 95% confidence interval, 1.061 to 2.274; p=0.036) than patients without them. Moreover, metabolic risk factors were independently associated with patients’ 90-day mortality (hazard ratio, 1.621; 95% confidence interval, 1.016 to 2.585; p=0.043). Prediabetes/diabetes and hypertension were related to higher rates of infection and worse renal function in HBV-ACLF patients.ConclusionsHBV-ACLF patients with metabolic risk factors, especially prediabetes/diabetes or hypertension, could have more severe disease and lower survival rates. In addition, the existence of metabolic disorder is an independent risk factor for HBV-ACLF patients’ 90-day mortality.

Altered peripheral blood monocyte phenotype correlate with MELD score in alcohol-related acute on chronic liver failure (A-ACLF) patients

Altered peripheral blood monocyte phenotype correlate with MELD score in alcohol-related acute on chronic liver failure (A-ACLF) patients

Plasma from alcohol-related acute on chronic liver failure (A-ACLF) patients alters healthy monocyte phenotype and function

Background and Aim: The pathogenic role of plasma in acute-on-chronic liver failure (ACLF) progression is suggested by effectiveness of plasma exchange therapy. Peripheral monocytes contribute to liver injury by migration to liver. In this exploratory study, we tested whether plasma-derived factors induce phenotypic and functional changes in monocytes that promote their liver-homing and inflammatory cytokine functionality.

Low Volume Plasma Exchange and Low Dose Steroid Improve Survival in Patients With Alcohol-Related Acute on Chronic Liver Failure and Severe Alcoholic Hepatitis – Preliminary Experience

Alcohol-related acute on chronic liver failure (A-ACLF) patients have high short-term mortality and are poor candidates for steroid therapy. Plasma exchange (PLEX) improves survival in ACLF patients. We analyzed our experience with low volume PLEX (50% of plasma volume exchanged per session) and low dose steroids to treat A-ACLF patients. We retrospectively compared the efficacy of low volume PLEX and low-dose steroids with standard medical treatment (SMT) in A-ACLF patients treated at our center between November 2017 to June 2019. The primary study outcome was one-year survival. Twenty-one A-ACLF patients in PLEX group [age 40 (29-56) years, median (range); MELD score 31 (29-46)] and 29 A-ACLF patients in SMT group [age 41.5 (28-63) years, MELD score 37 (21-48)] were studied. All 50 study patients had severe alcoholic hepatitis [mDF 84.7 (50-389)]. PLEX group patients had 3 (1-7) PLEX sessions with 1.5 (1.4-1.6) liters of plasma exchanged per session and oral Prednisolone 20mg daily, tapered over 1 month. Kaplan Meier analysis showed better survival over 1 year in the PLEX group compared to the SMT group (P=0.03). There was renal dysfunction in 10 patients in the PLEX group, which normalized in six patients after PLEX. In this preliminary report, compared to SMT, low volume PLEX and low dose steroid improved survival over one year in A-ACLF patients with severe alcoholic hepatitis. In patients with renal dysfunction, 60% showed improvement in renal function with PLEX. Studies with a larger number of patients are needed to validate these results.

Oral Health-Related Quality of Life in Chronic Liver Failure Patients Measured by OHIP-14 and GOHAI.

Background Oro-dental diseases are prevalent in chronic liver failure (CLF) patients. The aim of this study was to evaluate the quality of life associated with oral health in candidates for liver transplant surgery. Materials and Methods The demographic information of 105 end-stage liver cirrhotic patients was collected. All patients were ordered a panoramic view for pretransplant dental evaluation. The DMFT (decayed-missing-filled tooth) index was calculated for dental examination. The model for end-stage liver disease (MELD) was used for the severity of liver disease. The OHIP-14 (Oral Health Impact Profile) questionnaire and GOHAI (Geriatric Oral Health Assessment Index) questionnaire were applied to evaluate the impact of oral disease on the quality of life. Results A total of 79 patients thoroughly completed the questionnaires; 79.7% were male, 32.9% were over 50, and 25.3% were less than 30 years old. Further, 12.7% smoked, 2.5% were illiterate, 64.6% had not finished school, and 10.1% had university degrees. Almost half of the cirrhotic patients were suffering from the disease for more than 3 years. Most complaints reported by the patients as “very often” were becoming self-conscious (13.9%) and being uncomfortable when eating any foods (13.9%) followed by feeling tense (12.8%). There was no significant difference between gender, smoking, age, and MELD score based on quality of life (OHIP and GOHAI) (P > 0.05). The level of education (P = 0.020), duration of disease (P = 0.017), and DMFT index (P = 0.039) had a significant impact on oral health-related quality of life in CLF patients. An inverse relationship was seen between the DMFT index and the quality of life. Conclusion Oral health has a high impact on the quality of life of cirrhotic patients. The psychological dimension of oral health is the most debilitating factor affecting the quality of life. This shows the importance of professional oral care, oral health, and self-care education in this group of patients.

ABO-Incompatible Living Donor Liver Transplantation with Reduced Rituximab Dose: A Retrospective Analysis of 65 Patients - Can We Fast-Track Liver Transplant Surgery and Improve Long-Term Survival?

BackgroundABO-incompatible (ABO-i) living donor liver transplantation (LDLT) is a feasible alternative for donor liver allograft in emergency situations, especially in Asia, where deceased-donor organs remain scarce. The reported outcomes of ABO-i LDLT after optimal desensitization are comparable to those of ABO-compatible LDLT. In this retrospective study, we found improved outcomes after ABO-i LDLT with a low-dose rituximab in combination with double-filtration plasmapheresis (DFPP) and prophylactic antibiotic therapy.Material/MethodsBetween January 2006 and December 2018, a total of 65 recipients underwent ABO-i LDLT surgeries at our center. The study cohort consisted of 50 recipients (Era III) who underwent ABO-i LDLT using the recently updated desensitization protocol, which included rituximab 200 mg intravenous injection once a week prior to LDLT, 4 sessions of DFPP in all patients, and prophylactic antibiotics for 3 months.ResultsThe 3-year overall survival rate achieved in ABO-i LDLT patients was 72.7% (66.6% for Era I and 33.3% for Era II patients). In the study population, 11 patients developed complications due to infection. Five of these patients (10%) died due to overwhelming sepsis. Four patients (8%) were diagnosed with multiple strictures and diffusely scattered dilatation of intrahepatic bile ducts on computed tomography, without vascular complications. Three of them had evidence of antibody-mediated rejection (AMR).ConclusionsOur experience shows that the ABO-i LDLT protocol of lowered rituximab combined with pre-transplant sessions of plasmapheresis and a quadruple immunosuppressive regimen can be effective in chronic liver failure patients with clinical urgency in the absence of an ABO-compatible donor. Fast-tracking the use of ABO-i LDLT is feasible in patients with an acute liver failure (ALF) and can safely increase the donor liver pool, with an acceptable outcome.

Clinical Characteristics and Outcome of Acute on Chronic Liver Failure Patients at Fatmawati General Hospital

Background: Acute-on-chronic liver failure (ACLF) is a syndrome characterized by acute liver decompensation with extrahepatic organ failure in patients with pre-existing liver disease causing high short-term mortality. A good knowledge about characteristics and diagnostic of ACLF will help us to give proper treatment. The aim of this study is to know the profile and characteristics of ACLF patientMethod: Retrospective study was conducted to find patient with ACLF between January 2017-January 2018 at Fatmawati General Hospital.Results: Ten patients were diagnosed with ACLF. Six patients admitted with a chief complaint: unconscious, 2 of them had hematemesis in the course-of-treatment. Three patients were admitted with abdominal pain, and 1 patient with hematemesis-melena. Seven patients had Hepatitis-B infection. Aspartate-transaminase to platelet-ratio index (APRI) values varied (median 8.1;minimum 2.81-maximum 34.67). Hepatic encephalopathy, ascites, and acute renal failure were found in 90% of patients. Jaundice can be found in all patients, with mean values of bilirubin levels in patients undergoing test for bilirubin level were 18.56 mg/dL (9/10). Coagulation disorders were found in 60% of patients undergoing haemostasis test. Four patients were diagnosed with grade 3 ACLF. All ACLF patients eventually died during treatment, including third-degree patients who all died within 7 days. Only 2 patients survived more than 7 days, and 4 patients died within 3 days of treatment. Conclusion: mortality rates of ACLF were very high, and are often found in patients with advanced liver disease characterized by high APRI values. The prognosis is related to the number of organ failures. Central nervous system, kidneys and liver are the organs that are often impaired. Because the current treatment method is still limited, further research is needed, especially on biomarkers for better prevention, diagnosis and treatment.

Clinical Profile of Acute on Chronic Liver Failure Patients in a Tertiary Care Centre

Clinical Profile of Acute on Chronic Liver Failure Patients in a Tertiary Care Centre