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. 2022 Dec;8(4):300-308.
doi: 10.5114/ceh.2022.122332. Epub 2022 Dec 28.

Characteristics and predictors of short-term mortality in decompensated cirrhotic patients with acute-on-chronic liver failure

Ahmed Abudeif  1 , Eman Khalifa Al Sayed  1 , Ghada Moustapha Galal  1
Affiliations

Characteristics and predictors of short-term mortality in decompensated cirrhotic patients with acute-on-chronic liver failure

Ahmed Abudeif et al. Clin Exp Hepatol. 2022 Dec.

Abstract

Aim of the study: We aimed to investigate the characteristics of acute-on-chronic liver failure (ACLF) and factors associated with 28-day mortality in patients with ACLF.

Material and methods: This prospective study included ACLF patients based on the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium criteria, admitted between March 2021 and February 2022. We examined variables associated with 28-day mortality using multivariate Cox regression analysis.

Results: Of 326 patients admitted with acute decompensation (AD) of cirrhosis, 109 (33.44%) patients were diagnosed with ACLF (mean age 63.61 ±11.15 years, 65.14% males). Of these, 26.61%, 35.78%, and 37.61% of patients were in ACLF grades 1, 2, and 3 respectively. HCV (80.73%) was the main aetiology of cirrhosis. Upper gastrointestinal bleeding (25.69%) was the most common trigger. Kidney failure (73.39%) was the most common organ failure. The 28-day mortality rate was 66.97%. Cox regression analysis revealed that the existence of 2 (HR = 6.99, 95% CI: 2.68-18.25, p < 0.0001) or ≥ 3 (HR = 9.34, 95% CI: 3.6-24.74, p < 0.0001) organ failures, hepatic encephalopathy (HR = 2.96, 95% CI: 1.27-6.94, p = 0.01), and elevated serum bilirubin (HR = 1.03, 95% CI: 1.00-1.06, p = 0.04) were independent predictors for 28-day mortality, while shifting blood pH to the normal range was associated with a decrease in the HR of ACLF mortality (HR = 0.03, 95% CI: 0.002-0.44, p = 0.01).

Conclusions: ACLF has a very high 28-day mortality, which is associated with the existence of 2 or more organ failures, hepatic encephalopathy, elevated serum bilirubin, and low blood pH.

Keywords: acute decompensation of cirrhosis; acute-on-chronic liver failure; predictors of ACLF mortality; prevalence of ACLF.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1
Fig. 1
Flow chart of study patients
Fig. 2
Fig. 2
Kaplan-Meier plots demonstrating the possibility of overall survival at 28 days: A) All ACLF patients. B) According to the grade of ACLF
Fig. 3
Fig. 3
Outcome at 28 days by ACLF grade
See this image and copyright information in PMC

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