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. 2023 Oct 3;7(10):717-723.
doi: 10.1002/jgh3.12974. eCollection 2023 Oct.

Acute on chronic liver failure: A South Australian experience

Shauna Madigan  1   2 , Yasmina Tashkent  1   2 , Sharad Trehan  3 , Kate Muller  1   2 , Alan Wigg  1   2 , Richard Woodman  2 , Jeyamani Ramachandran  1   2
Affiliations

Acute on chronic liver failure: A South Australian experience

Shauna Madigan et al. JGH Open. .

Abstract

Background and aim: Acute on chronic liver failure (ACLF) is a clinical syndrome described in patients with acute decompensation (AD) of cirrhosis, characterized by organ failures and high mortality. Intensive management, including liver transplantation (LT), has been shown to improve survival. To address the limited Australian data on ACLF, we describe the prevalence, clinical profile, and outcome of ACLF in an Australian cohort of hospitalized patients.

Methods: A retrospective review of hepatology admissions in a tertiary hospital from 1 January 2017 to 31 December 2019 identified AD and ACLF cohorts, as defined by the European Association for Study of the Liver definition. Patient characteristics, clinical course, survival at 28- and 90-day survival, and feasibility of LT were analyzed.

Results: Among the 192 admissions with AD, 74 admissions (39%) met ACLF criteria. A prior diagnosis of alcohol-related cirrhosis was highly prevalent in both cohorts. Grade-1 ACLF was the most frequent (60%), with renal failure being the commonest organ failure; 28-day (23% vs 2%, P = <0.001) and 90-day mortality (36% vs 16%, P = 0.002) were higher in ACLF than AD. Due to ongoing alcohol use disorder (AUD), only six patients underwent LT assessment during ACLF admission.

Conclusion: ACLF was common in our cohort of cirrhosis with AD and was associated with high mortality. AUD despite prior cirrhosis diagnosis was a barrier to LT. Prioritization of ACLF patients for LT after addressing AUD and relaxation of the 6-month abstinence rule may improve ACLF survival and should be addressed in prospective studies.

Keywords: alcohol use disorder; hepatic encephalopathy; liver failure; organ failure.

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Figures

Figure 1
Figure 1
Study flowchart showing inclusion and exclusion criteria. ACLF, acute on chronic liver failure; AD, acute decompensation; CLD, chronic liver disease, ICCU, intensive and critical care unit, TACE, transarterial chemo embolization,TIPS, transjugular intrahepatic porto systemic shunt
Figure 2
Figure 2
Kaplan–Meier curves and differences in survival rates in acute on chronic liver failure (ACLF) and acute decompensation (AD) of cirrhosis compared using log‐rank test. (formula image), ACLF; (formula image), AD
See this image and copyright information in PMC

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