. 2022 Feb;16(1):171-182.

doi: 10.1007/s12072-021-10266-8. Epub 2021 Nov 25.

Impact of compensated cirrhosis on survival in patients with acute-on-chronic liver failure

Kessarin Thanapirom^{1

2}, Tongluk Teerasarntipan¹, Sombat Treeprasertsuk³, Ashok Choudhury⁴, Manoj K Sahu⁵, Rakhi Maiwall⁶, Viniyendra Pamecha⁷, Richard Moreau^{8

9

10

11}, Mamun Al Mahtab¹², Yogesh Kumar Chawla¹³, Harshad Devarbhavi¹⁴, Chen Yu¹⁵, Qin Ning¹⁶, Deepak Amarapurkar¹⁷, Chundamannil E Eapen¹⁸, Saeed Sadiq Hamid¹⁹, Amna Subhan Butt¹⁹, Dong Joon Kim²⁰, Guan H Lee²¹, Ajit Sood²², Laurentious A Lesmana²³, Zaigham Abbas²⁴, Gamal Shiha²⁵, Diana A Payawal²⁶, Man-Fung Yuen²⁷, Albert Chan²⁷, George Lau²⁸, Jidong Jia²⁹, Salimur Rahman¹², Barjesh C Sharma^{30

31}, Osamu Yokosuka³², Shiv Kumar Sarin³³; APASL ACLF Working Party

Collaborators, Affiliations

Collaborators

APASL ACLF Working Party:
Shiv Kumar Sarin, Ashok Choudhury, Manoj K Sharma, Rakhi Maiwall, Mamun Al Mahtab, Salimur Rahman, Sanjiv Saigal, Neeraj Saraf, A S Soin, Harshad Devarbhavi, Dong Joon Kim, R K Dhiman, Ajay Duseja, Sunil Taneja, C E Eapen, Ashish Goel, Q Ning, Tao Chen, Ke Ma, Z Duan, Chen Yu, Sombat Treeprasertsuk, S S Hamid, Amna S Butt, Wasim Jafri, Akash Shukla, Vivek Saraswat, Soek Siam Tan, Ajit Sood, Vandana Midha, Omesh Goyal, Hasmik Ghazinyan, Anil Arora, Jinhua Hu, Manoj Sahu, P N Rao, Guan H Lee, Seng G Lim, Laurentius A Lesmana, Cosmas Rinaldi Lesmana, Samir Shah, V G Mohan Prasad, Diana A Payawal, Zaigham Abbas, A Kadir Dokmeci, Jose D Sollano, Gian Carpio, Ananta Shresta, G K Lau, Md Fazal Karim, Gamal Shiha, Rino Gani, Kemal Fariz Fariz Kalista, Man-Fung Yuen, Seema Alam, Rajeev Khanna, Vikrant Sood, Bikrant Bihari Lal, Viniyendra Pamecha, Ankur Jindal, V Rajan, Vinod Arora, Osamu Yokosuka, Madunil A Niriella, Hai Li, Xiaolong Qi, Atsushi Tanaka, Satoshi Mochida, Dominic Ray Chaudhuri, Ed Gane, Khin Maung Win, Wei Ting Chen, Mohd Rela, Dharmesh Kapoor, Amit Rastogi, Pratibha Kale, Archana Rastogi, Chhagan Bihari Sharma, Meenu Bajpai, Virender Singh, Madhumita Premkumar, Sudhir Sudhir, A Olithselvan, Cyriac Abby Philips, Anshu Srivastava, Surender K Yachha, Zeeshan Ahmad Wani, B R Thapa, Anoop Saraya, Shalimar, Ashish Kumar, Manav Wadhawan, Subash Gupta, Kaushal Madan, Puja Sakhuja, Vivek Vij, Barjesh C Sharma, Hitendra Garg, Vishal Garg, Chetan Kalal, Lovkesh Anand, Tanmay Vyas, Rajan P Mathur, Guresh Kumar, Priyanka Jain, Samba Siva Rao Pasupuleti, Yogesh K Chawla, Abhijit Chowdhury, Shahinul Alam, Do Seon Song, Jin Mo Yang

Affiliations

¹ Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Thai Red Cross, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Pathumwan, Bangkok, Thailand.
² Liver Fibrosis and Cirrhosis Research Unit, Chulalongkorn University, Bangkok, Thailand.
³ Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Thai Red Cross, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Pathumwan, Bangkok, Thailand. battan5410@gmail.com.
⁴ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
⁵ IMS &SUM Hospital, Bhubaneswar, Odisha, India.
⁶ Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, India.
⁷ Department of Liver Transplantation and Hepato Pancreatico Biliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.
⁸ EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain.
⁹ Inserm, U1149, Centre de Recherche Sur L'Inflammation (CRI),, Paris, France.
¹⁰ UMRS1149, Université de Paris, Paris, France.
¹¹ Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France.
¹² Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
¹³ PGIMER, Chandigarh, India.
¹⁴ St John's Medical College, Bangalore, India.
¹⁵ Beijing Youan Hospital and Translational Hepatology Institute, Beijing, China.
¹⁶ Tongji Hospital, Tongji Medical College, Wuhan, China.
¹⁷ Department of Gastroenterology, Bombay Hospital and Medical Research Centre, Mumbai, India.
¹⁸ CMC, Vellore, India.
¹⁹ Aga Khan University Hospital, Karachi, Pakistan.
²⁰ Hallym University College of Medicine, Chuncheon, South Korea.
²¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
²² Dayanand Medical College, Ludhiana, India.
²³ Digestive Disease & Oncology Centers, Medistra Hospital, Jakarta, Indonesia.
²⁴ Ziauddin University, Karachi, Pakistan.
²⁵ Egyptian Liver Research Institute and Hospital, Cairo, Egypt.
²⁶ Cardinal Santos Medical Center, San Jaun, Philippines.
²⁷ Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong.
²⁸ Department of Medicine, Humanity and Health Medical Group, New Kowloon, Hongkong, China.
²⁹ Friendship Hospital, Capital University, Beijing, China.
³⁰ Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India.
³¹ Department of Advanced Endoscopy, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India.
³² Chiba University, Chiba, Japan.
³³ Institute of Liver and Biliary Sciences, New Delhi, India.

PMID: 34822057
PMCID: PMC8844167
DOI: 10.1007/s12072-021-10266-8

Impact of compensated cirrhosis on survival in patients with acute-on-chronic liver failure

Kessarin Thanapirom et al. Hepatol Int. 2022 Feb.

. 2022 Feb;16(1):171-182.

doi: 10.1007/s12072-021-10266-8. Epub 2021 Nov 25.

Authors

Collaborators

APASL ACLF Working Party:
Shiv Kumar Sarin, Ashok Choudhury, Manoj K Sharma, Rakhi Maiwall, Mamun Al Mahtab, Salimur Rahman, Sanjiv Saigal, Neeraj Saraf, A S Soin, Harshad Devarbhavi, Dong Joon Kim, R K Dhiman, Ajay Duseja, Sunil Taneja, C E Eapen, Ashish Goel, Q Ning, Tao Chen, Ke Ma, Z Duan, Chen Yu, Sombat Treeprasertsuk, S S Hamid, Amna S Butt, Wasim Jafri, Akash Shukla, Vivek Saraswat, Soek Siam Tan, Ajit Sood, Vandana Midha, Omesh Goyal, Hasmik Ghazinyan, Anil Arora, Jinhua Hu, Manoj Sahu, P N Rao, Guan H Lee, Seng G Lim, Laurentius A Lesmana, Cosmas Rinaldi Lesmana, Samir Shah, V G Mohan Prasad, Diana A Payawal, Zaigham Abbas, A Kadir Dokmeci, Jose D Sollano, Gian Carpio, Ananta Shresta, G K Lau, Md Fazal Karim, Gamal Shiha, Rino Gani, Kemal Fariz Fariz Kalista, Man-Fung Yuen, Seema Alam, Rajeev Khanna, Vikrant Sood, Bikrant Bihari Lal, Viniyendra Pamecha, Ankur Jindal, V Rajan, Vinod Arora, Osamu Yokosuka, Madunil A Niriella, Hai Li, Xiaolong Qi, Atsushi Tanaka, Satoshi Mochida, Dominic Ray Chaudhuri, Ed Gane, Khin Maung Win, Wei Ting Chen, Mohd Rela, Dharmesh Kapoor, Amit Rastogi, Pratibha Kale, Archana Rastogi, Chhagan Bihari Sharma, Meenu Bajpai, Virender Singh, Madhumita Premkumar, Sudhir Sudhir, A Olithselvan, Cyriac Abby Philips, Anshu Srivastava, Surender K Yachha, Zeeshan Ahmad Wani, B R Thapa, Anoop Saraya, Shalimar, Ashish Kumar, Manav Wadhawan, Subash Gupta, Kaushal Madan, Puja Sakhuja, Vivek Vij, Barjesh C Sharma, Hitendra Garg, Vishal Garg, Chetan Kalal, Lovkesh Anand, Tanmay Vyas, Rajan P Mathur, Guresh Kumar, Priyanka Jain, Samba Siva Rao Pasupuleti, Yogesh K Chawla, Abhijit Chowdhury, Shahinul Alam, Do Seon Song, Jin Mo Yang

Affiliations

¹ Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Thai Red Cross, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Pathumwan, Bangkok, Thailand.
² Liver Fibrosis and Cirrhosis Research Unit, Chulalongkorn University, Bangkok, Thailand.
³ Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Thai Red Cross, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Pathumwan, Bangkok, Thailand. battan5410@gmail.com.
⁴ Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India.
⁵ IMS &SUM Hospital, Bhubaneswar, Odisha, India.
⁶ Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, India.
⁷ Department of Liver Transplantation and Hepato Pancreatico Biliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India.
⁸ EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain.
⁹ Inserm, U1149, Centre de Recherche Sur L'Inflammation (CRI),, Paris, France.
¹⁰ UMRS1149, Université de Paris, Paris, France.
¹¹ Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France.
¹² Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
¹³ PGIMER, Chandigarh, India.
¹⁴ St John's Medical College, Bangalore, India.
¹⁵ Beijing Youan Hospital and Translational Hepatology Institute, Beijing, China.
¹⁶ Tongji Hospital, Tongji Medical College, Wuhan, China.
¹⁷ Department of Gastroenterology, Bombay Hospital and Medical Research Centre, Mumbai, India.
¹⁸ CMC, Vellore, India.
¹⁹ Aga Khan University Hospital, Karachi, Pakistan.
²⁰ Hallym University College of Medicine, Chuncheon, South Korea.
²¹ Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore.
²² Dayanand Medical College, Ludhiana, India.
²³ Digestive Disease & Oncology Centers, Medistra Hospital, Jakarta, Indonesia.
²⁴ Ziauddin University, Karachi, Pakistan.
²⁵ Egyptian Liver Research Institute and Hospital, Cairo, Egypt.
²⁶ Cardinal Santos Medical Center, San Jaun, Philippines.
²⁷ Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong.
²⁸ Department of Medicine, Humanity and Health Medical Group, New Kowloon, Hongkong, China.
²⁹ Friendship Hospital, Capital University, Beijing, China.
³⁰ Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India.
³¹ Department of Advanced Endoscopy, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India.
³² Chiba University, Chiba, Japan.
³³ Institute of Liver and Biliary Sciences, New Delhi, India.

PMID: 34822057
PMCID: PMC8844167
DOI: 10.1007/s12072-021-10266-8

Abstract

Background and aims: Acute-on-chronic liver failure (ACLF) is considered a main prognostic event in patients with chronic liver disease (CLD). We analyzed the 28-day and 90-day mortality in ACLF patients with or without underlying cirrhosis enrolled in the ACLF Research Consortium (AARC) database.

Methods: A total of 1,621 patients were prospectively enrolled and 637 (39.3%) of these patients had cirrhosis. Baseline characteristics, complications and mortality were compared between patients with and without cirrhosis.

Results: Alcohol consumption was more common in cirrhosis than non-cirrhosis (66.4% vs. 44.2%, p < 0.0001), while non-alcoholic fatty liver disease/cryptogenic CLD (10.9% vs 5.8%, p < 0.0001) and chronic HBV reactivation (18.8% vs 11.8%, p < 0.0001) were more common in non-cirrhosis. Only 0.8% of patients underwent liver transplantation. Overall, 28-day and 90-day mortality rates were 39.3% and 49.9%, respectively. Patients with cirrhosis had a greater chance of survival compared to those without cirrhosis both at 28-day (HR = 0.48; 95% CI 0.36-0.63, p < 0.0001) and 90-day (HR = 0.56; 95% CI 0.43-0.72, p < 0.0001), respectively. In alcohol CLD, non-cirrhosis patients had a higher 28-day (49.9% vs. 23.6%, p < 0.001) and 90-day (58.4% vs. 35.2%, p < 0.001) mortality rate than cirrhosis patients. ACLF patients with cirrhosis had longer mean survival than non-cirrhosis patients (25.5 vs. 18.8 days at 28-day and 65.2 vs. 41.2 days at 90-day). Exaggerated systemic inflammation might be the reason why non-cirrhosis patients had a poorer prognosis than those with cirrhosis after ACLF had occurred.

Conclusions: The 28-day and 90-day mortality rates of ACLF patients without cirrhosis were significantly higher than those with cirrhosis in alcoholic CLD. The presence of cirrhosis and its stage should be evaluated at baseline to guide for management. Thai Clinical Trials Registry, TCTR20191226002.

Keywords: Acute-on-chronic liver failure; Chronic liver disease; Cirrhosis; Liver injury; Mortality; Prognosis.

PubMed Disclaimer

Conflict of interest statement

Kessarin Thanapirom, Tongluk Teerasarntipan, Sombat Treeprasertsuk, Ashok Choudhury, Manoj K Sahu, Rakhi Maiwall, Viniyendra Pamecha, Richard Moreau, Mamun Al Mahtab, Yogesh Kumar Chawla, Harshad Devarbhavi, Chen Yu, Qin Ning, Deepak Amarapurkar, Chundamannil E. Eapen, Saeed Sadiq Hamid, Amna Subhan Butt, Dong Joon Kim, Guan H. Lee, Ajit Sood, Laurentious A. Lesmana, Zaigham Abbas, Gamal Shiha, Diana A Payawal , Man-Fung Yuen, Albert Chan, George Lau, Jidong Jia, Salimur Rahman, Barjesh C Sharma, Osamu Yokosuka, Shiv Kumar Sarin have nothing to disclose.

Figures

**Fig. 1**
The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) flowchart of patient enrolment

**Fig. 2**
Survival according to the presence of cirrhosis or non-cirrhosis in patients with ACLF at 28 days and 90 days. a Survival curves at 28 days (Log Rank Chi-Square = 79.5; p < 0.0001). b Survival curves at 90 days (Log Rank Chi-Square = 73.3; p < 0.0001)

See this image and copyright information in PMC

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Impact of compensated cirrhosis on survival in patients with acute-on-chronic liver failure

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Impact of compensated cirrhosis on survival in patients with acute-on-chronic liver failure

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Conflict of interest statement

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