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. 2022 Mar 10;6(3):205-212.
doi: 10.1002/jgh3.12719. eCollection 2022 Mar.

Acute-on-chronic liver failure: Epidemiology, prognosis, and outcome of a multicenter study in Thai population

Sakkarin Chirapongsathorn  1 , Tongluk Teerasarntipan  2 , Krit Tipchaichatta  1 , Tanita Suttichaimongkol  3 , Naichaya Chamroonkul  4 , Chalermrat Bunchorntavakul  5 , Sith Siramolpiwat  6 , Siwaporn Chainuvati  7 , Abhasnee Sobhonslidsuk  8 , Apinya Leerapun  9 , Teerha Piratvisuth  4 , Wattana Sukeepaisarnjaroen  3 , Tawesak Tanwandee  7 , Sombat Treeprasertsuk  2
Affiliations

Acute-on-chronic liver failure: Epidemiology, prognosis, and outcome of a multicenter study in Thai population

Sakkarin Chirapongsathorn et al. JGH Open. .

Abstract

Background and aim: Acute-on-chronic liver failure (ACLF) leads to multi-organ failure related to high mortality rates. This study aimed to gather epidemiological data and validate a scoring system to predict mortality in ACLF.

Methods: This retrospective cohort study collected data from multicenter tertiary care hospitals in Thailand. A total of 638 hospitalized patients (acute decompensated liver disease [ADLD], 292 patients; ACLF, 346 patients) from January 2019 to June 2020 were enrolled in this study. We compared the mortality rate at days 30 and 90 between patients with ADLD and ACLF. Areas under the receiver operating characteristic (AUROC) curves of chronic liver failure-sequential organ failure assessment (CLIF-SOFA) and other existing scoring systems were compared among patients with ACLF.

Results: The incidence of patients with ACLF was 54%. The main cause of chronic liver disease was alcohol (38%), with sepsis (50%) as the most common precipitating factor. ACLF with coagulopathy (AUROC 0.58, 95% confidence interval [CI]: 0.52-0.64), metabolic acidosis (AUROC 0.58, 95% CI: 0.52-0.64), and high aspartate aminotransferase (AST) (AUROC 0.59, 95% CI: 0.53-0.66) were associated with high 30-day mortality. The 30-day mortality rate of patients with acute decompensation and patients with ACLF was 46 and 58%, respectively. Respiratory system (P = 0.001) failure was the major end result in ACLF and constituted a significant factor to predict mortality. The AUROC of CLIF-SOFA score was superior to that of the other predicted score (AUROC 0.64, 95% CI: 0.585-0.704).

Conclusion: Patients with ACLF with more organ failure and high CLIF-SOFA score were associated with high short-term mortality. Future studies should include an ACLF prospective registry to confirm these finding.

Keywords: acute‐on‐chronic liver failure; cirrhosis; organ failure.

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Figures

Figure 1
Figure 1
Comparisons of the receiver operating characteristic (ROC) curves for 30‐day mortality at admission by INR, aspartate aminotransferase (AST), serum bicarbonate, and medical scores. Source of the curve: (formula image), INR; (formula image), AST; (formula image), HCO3; (formula image), MELD; (formula image), MELD‐Na; (formula image), chronic liver failure (CLIF)–sequential organ failure assessment; (formula image), CLIF‐OF; (formula image), CLIF‐C; (formula image), ACLF grade by CLIF‐SOFA; (formula image), reference line.
Figure 2
Figure 2
Comparisons of the receiver operating characteristic (ROC) curves for 90‐day mortality at admission by INR, aspartate aminotransferase (AST), serum bicarbonate, and medical scores. Source of the curve: (formula image), INR; (formula image), AST; (formula image), HCO3; (formula image), model for end‐stage liver disease (MELD); (formula image), MELD‐Na; (formula image), CLIF‐SOFA; (formula image), CLIF‐OF; (formula image), CLIF‐C; (formula image), ACLF grade by CLIF‐SOFA; (formula image), reference line
See this image and copyright information in PMC

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