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. 2024 May 27;16(5):809-821.
doi: 10.4254/wjh.v16.i5.809.

Characterization of acute-on-chronic liver diseases: A multicenter prospective cohort study

Yuan-Yao Zhang  1 , Sen Luo  1 , Hai Li  2 , Shu-Ning Sun  3 , Xian-Bo Wang  4 , Xin Zheng  5 , Yan Huang  6 , Bei-Ling Li  7 , Yan-Hang Gao  8 , Zhi-Ping Qian  9 , Feng Liu  10 , Xiao-Bo Lu  11 , Jun-Ping Liu  12 , Hao-Tang Ren  13 , Yu-Bao Zheng  14 , Hua-Dong Yan  15 , Guo-Hong Deng  3 , Liang Qiao  16 , Yan Zhang  2 , Wen-Yi Gu  2 , Xiao-Mei Xiang  3 , Yi Zhou  3   11 , Yi-Xin Hou  4 , Qun Zhang  4 , Yan Xiong  5 , Cong-Cong Zou  5 , Jun Chen  17 , Ze-Bing Huang  17 , Xiu-Hua Jiang  7 , Ting-Ting Qi  7 , Yuan-Yuan Chen  1 , Na Gao  8 , Chun-Yan Liu  8 , Wei Yuan  9 , Xue Mei  9 , Jing Li  12 , Tao Li  12 , Rong-Jiong Zheng  11 , Xin-Yi Zhou  11 , Jun Zhao  18 , Zhong-Ji Meng  19
Affiliations

Characterization of acute-on-chronic liver diseases: A multicenter prospective cohort study

Yuan-Yao Zhang et al. World J Hepatol. .

Abstract

Background: Acute-on-chronic liver disease (AoCLD) accounts for the majority of patients hospitalized in the Department of Hepatology or Infectious Diseases.

Aim: To explore the characterization of AoCLD to provide theoretical guidance for the accurate diagnosis and prognosis of AoCLD.

Methods: Patients with AoCLD from the Chinese Acute-on-Chronic Liver Failure (ACLF) study cohort were included in this study. The clinical characteristics and outcomes, and the 90-d survival rate associated with each clinical type of AoCLD were analyzed, using the Kaplan-Meier method and the log-rank test.

Results: A total of 3375 patients with AoCLD were enrolled, including 1679 (49.7%) patients with liver cirrhosis acute decompensation (LC-AD), 850 (25.2%) patients with ACLF, 577 (17.1%) patients with chronic hepatitis acute exacerbation (CHAE), and 269 (8.0%) patients with liver cirrhosis active phase (LC-A). The most common cause of chronic liver disease (CLD) was HBV infection (71.4%). The most common precipitants of AoCLD was bacterial infection (22.8%). The 90-d mortality rates of each clinical subtype of AoCLD were 43.4% (232/535) for type-C ACLF, 36.0% (36/100) for type-B ACLF, 27.0% (58/215) for type-A ACLF, 9.0% (151/1679) for LC-AD, 3.0% (8/269) for LC-A, and 1.2% (7/577) for CHAE.

Conclusion: HBV infection is the main cause of CLD, and bacterial infection is the main precipitant of AoCLD. The most common clinical type of AoCLD is LC-AD. Early diagnosis and timely intervention are needed to reduce the mortality of patients with LC-AD or ACLF.

Keywords: Acute-on-chronic liver disease; Acute-on-chronic liver failure; Clinical features; Liver cirrhosis; Prognosis.

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Conflict of interest statement

Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.

Figures

Figure 1
Figure 1
Flow chart of patient enrollment. AoCLD: Acute-on-chronic liver disease; CHAE: Chronic hepatitis with acute exacerbation; LC-A: Liver cirrhosis active phase; LC-AD: Liver cirrhosis acute decompensation; ACLF: Acute-on-chronic liver failure; LT: Liver transplantation; CATCH-LIEF: Chinese Acute-on-Chronic Liver Failure study; AD: Acute decompensation.
Figure 2
Figure 2
Constitution of clinical types of acute-on-chronic liver disease. CHAE: Chronic hepatitis with acute exacerbation; LC-A: Liver cirrhosis active phase; LC-AD: Liver cirrhosis acute decompensation; ACLF: Acute-on-chronic liver failure.
Figure 3
Figure 3
The 28-d and 90-d survival curves of each clinical subtype of acute-on-chronic liver disease. A and B: 28-d (A) and 90-d (B) survival curves of non-acute-on-chronic liver failure (ACLF) and ACLF; C and D: 28-d (C) and 90-d (D) survival curves of each clinical type of non-ACLF; E and F: 28-d (E) and 90-d (F) survival curves of each clinical type of ACLF. CHAE: Chronic hepatitis with acute exacerbation; LC-A: Liver cirrhosis active phase; LC-AD: Liver cirrhosis acute decompensation; ACLF: Acute-on-chronic liver failure; HR: Hazard ratio.
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