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Acute-on-chronic liver failure: A prospective study to determine the clinical profile, outcome, and factors predicting mortality

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Indian Journal of Gastroenterology Aims and scope Submit manuscript

Abstract

Background

Acute-on-chronic liver failure (ACLF), defined differently by different associations, lacks consensus on clinical profile, precipitating events and factors predicting mortality. This prospective multicentric study was conducted to determine the relevance of European Association for Study of Liver (EASL) and Asia Pacific Association for Study of Liver (APASL) definitions and to determine prognostic factors predicting the survival.

Methods

Consecutive patients over a 3-month period with any form of acute deterioration were evaluated for presence of ACLF, as defined by APASL or EASL-Chronic Liver Failure (CLIF) criteria. Those enrolled underwent complete evaluation for identifying the acute insults, underlying chronic etiologies, presence of organ failures, and short-term survival.

Results

Sixty-two patients (median age 53 years, 51 males) who presented with either raised bilirubin (n = 52), international normalized ratio (INR) >1.5 (n = 46), new onset ascites (n = 53), or hepatic encephalopathy (n = 39) were included in study. Forty-four patients (36 males, 25 alcoholics) satisfied APASL definition of ACLF, with a mortality rate of 43.1 %. Hepatic encephalopathy (p-value 0.022) was significantly associated with mortality. By CLIF-Sequential Organ Failure Assessment (SOFA) score criteria for organ failure, 50 patients (80.6 %) had at least 1 organ failure whereas 15 had ≥3 organ failures (mortality rate >75 %). Twenty-nine patients classified as ACLF (1, 2, or 3) as per EASL-CLIF criteria. Bacterial infection, >1 precipitating event, additional organ failure, total leukocyte count, INR, and serum creatinine were significantly higher in patients with ACLF across all grades. Mortality rates were 6.6 and >60 % in patients with ACLF only by APASL criteria vs. by both criteria, respectively.

Conclusions

ACLF, as defined by APASL in terms of liver failure, identified some patients with better survival rates as compared to EASL-CLIF definition which identifies presence of additional organ failures and high mortality.

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Conflict of interest

DA, MVD, MC, RB, PK, MJ, NP, PK, SI, NS, SK, SG, AS, and SD all confirm that they have no conflict of interest to declare.

Ethics statement

The study was performed in a manner to conform to the Helsinki Declaration of 1975, as revised in 2000 and 2008 concerning human and animal rights, and that the authors followed the policy concerning informed consent as shown on Springer.com.

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Authors and Affiliations

  1. Bombay Hospital and Medical Research Center, 12, Marine Lines, Mumbai, 400 020, India

    Deepak Amarapurkar, Mrudul V Dharod, Madhuri Chandnani, Sonali Gautam & Apurva Shah

  2. Jagjeevanram Western Railway Hospital, Mumbai Central, Behind Maratha Mandir, Mumbai, 400 008, India

    Rajiv Baijal, Praveen Kumar, Nimish Shah, Sandeep Kulkarni & Soham Doshi

  3. Choitharam Hospital and Research Centre, Choithram College of Nursing, Manik Bagh Road, Indore, 452 014, India

    Mayank Jain

  4. Jeevandeep Hospital, Shubhlaxmi Shopping Center, Station Road, Anand, 388 001, India

    Nikhil Patel

  5. N M Virani Wockhardt Hospital, Kalawad Road, Rajkot, 360 007, India

    Praful Kamani

  6. Jawaharlal Nehru Hospital, Sector 9, Bhilai, Durg, Chhattisgarh, 490 001, India

    Sanjeev Issar

Authors
  1. Deepak Amarapurkar
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  2. Mrudul V Dharod
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  3. Madhuri Chandnani
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  4. Rajiv Baijal
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  5. Praveen Kumar
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  6. Mayank Jain
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  7. Nikhil Patel
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  8. Praful Kamani
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  9. Sanjeev Issar
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  10. Nimish Shah
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  11. Sandeep Kulkarni
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  12. Sonali Gautam
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  13. Apurva Shah
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  14. Soham Doshi
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Corresponding author

Correspondence to Mrudul V Dharod.

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Amarapurkar, D., Dharod, M.V., Chandnani, M. et al. Acute-on-chronic liver failure: A prospective study to determine the clinical profile, outcome, and factors predicting mortality. Indian J Gastroenterol 34, 216–224 (2015). https://doi.org/10.1007/s12664-015-0574-3

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  • DOI: https://doi.org/10.1007/s12664-015-0574-3

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