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. 2024 Mar 28;12(3):257-265.
doi: 10.14218/JCTH.2023.00379. Epub 2024 Jan 31.

Impact of Onset Time, Number, Type, and Sequence of Extrahepatic Organ Failure on Prognosis of Acute-on-chronic Liver Failure

Shaotian Qiu  1   2 , Qian Zhang  3   4 , Jiaxuan Hu  1   2 , Lewei Wang  5 , Rui Chen  5 , Yingying Cao  6 , Fang Liu  6 , Zhenjun Yu  3 , Caiyan Zhao  7 , Liaoyun Zhang  8 , Wanhua Ren  9 , Shaojie Xin  10 , Yu Chen  11 , Zhongping Duan  11 , Tao Han  1   2   3   4   5   6
Affiliations

Impact of Onset Time, Number, Type, and Sequence of Extrahepatic Organ Failure on Prognosis of Acute-on-chronic Liver Failure

Shaotian Qiu et al. J Clin Transl Hepatol. .

Abstract

Background and aims: The impact of the characteristics of extrahepatic organ failure (EHOF) including the onset time, number, type, and sequence on the prognosis of acute-on-chronic liver failure (ACLF) patients remains unknown. This study aimed to identify the association between the characteristics of EHOF and the prognosis of ACLF patients.

Methods: ACLF subjects enrolled at six hospitals in China were included in the analysis. The risk of mortality based on the characteristics of EHOF was evaluated. Survival of study groups was compared by Kaplan-Meier analysis and log-rank tests.

Results: A total of 736 patients with ACLF were included. EHOF was observed in 402 patients (54.6%), of which 295 (73.4%) developed single EHOF (SEHOF) and 107 (26.6%) developed multiple EHOF (MEHOF). The most commonly observed EHOF was coagulation failure (47.0%), followed by renal (13.0%), brain (4.9%), respiratory (4.3%), and circulatory (2.3%) failure. Survival analysis found that MEHOF or SEHOF patients with brain failure had a worse prognosis. However, no significant outcome was found in the analysis of the effect of onset time and sequence of failed organs on prognosis. Patients were further divided into three risk subgroups by the EHOF characteristics. Kaplan-Meier analysis showed that risk stratification resulted in the differentiation of patients with different risks of mortality both in the training and validation cohorts.

Conclusions: The mortality of ACLF patients was determined by the number and type, but not the onset time and sequence of EHOF. Risk stratification applicable to clinical practice was established.

Keywords: Acute-on-chronic liver failure; Brain failure; Extrahepatic organ failure; Prognosis.

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Conflict of interest statement

The authors have no conflict of interests related to this publication.

Figures

Fig. 1
Fig. 1. Inclusion and exclusion flowchart of ACLF patients.
ACLF, acute-on-chronic liver failure; EHOF, extrahepatic organ failure.
Fig. 2
Fig. 2. Type and number of EHOF in ACLF patients.
ACLF, acute-on-chronic liver failure; EHOF, extrahepatic organ failure.
Fig. 3
Fig. 3. Distribution of ACLF patients with EHOF.
(A–C) Onset (A), number of organs affected (B), and sequence of organ failed (C) in patients with MEHOF (n=107). Simul: Two or more organ failures diagnosed simultaneously. ACLF, acute-on-chronic liver failure; Coag, coagulation; EHOF, extra-hepatic organ failure; MEHOF, multiple extrahepatic organ failures; RC, respiratory or circulatory failure.
Fig. 4
Fig. 4. Kaplan–Meier analysis of ACLF patients.
(A–D) Training cohort (A), HBV-related ACLF (B), alcohol-related ACLF patients (C) and validation cohort (D) based on risk stratification. Group 1, low-risk subgroup; Group 2, middle-risk subgroup; Group 3, high-risk subgroup. ACLF, acute-on-chronic liver failure; HBV, hepatitis B virus.
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