Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure.

Abstract

BACKGROUND:

Acute-on-chronic liver failure (ACLF) is characterised by acute hepatic insult manifesting as jaundice and coagulopathy, complicated within 4 weeks by ascites and/or encephalopathy in patients with previously diagnosed or undiagnosed chronic liver disease. We studied the clinical, biochemical and etiological profiles of ACLF patients investigating variables which could predict mortality.

METHODS:

Consecutive ACLF patients were enrolled and given standard intensive care management. They were monitored for predictors of 90-day mortality.

RESULTS:

91 patients were included; besides jaundice (median bilirubin 23.1mg/dL) and coagulopathy, acute onset ascites with or without encephalopathy was the presenting symptom in 92%. In all patients a first diagnosis of chronic liver disease was made, mainly due to hepatitis B (37%) or alcohol (34%). Reactivation of chronic hepatitis B and alcoholic hepatitis were the common acute insults. The 90-day mortality was 63%. On multivariate analysis, hepatic encephalopathy, low serum sodium, and high INR were found to be independent baseline predictors of mortality. Amongst all severity scores studied, MELD, SOFA and APACHE-II scores had AUROCs of >0.8 which was significantly higher than that of Child-Turcotte-Pugh.

CONCLUSIONS:

ACLF has very high mortality. Hepatic encephalopathy, low serum sodium and high INR predict poor outcome. Mortality can also be predicted by baseline MELD, SOFA or APACHE-II scores.

• Authors: Hitendra Garg, Ashish Kumar, Vishal Garg, Praveen Sharma, Barjesh Chander Sharma, Shiv Kumar Sarin
• Journal: Digestive and liver disease : official journal of the Italian Society of Gastroenterology and the Italian Association for the Study of the Liver (Dig Liver Dis) Vol. 44 Issue 2 Pg. 166-71 (Feb 2012) ISSN: 1878-3562 [Electronic] Netherlands
• PMID: 21978580 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2011 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.

Topics

• Adolescent
• Adult
• Aged
• Aged, 80 and over
• Disease Progression
• End Stage Liver Disease (complications, diagnosis, mortality)
• Female
• Follow-Up Studies
• Humans
• Incidence
• India (epidemiology)
• Jaundice (diagnosis, epidemiology, etiology)
• Liver Failure, Acute (complications, diagnosis, mortality)
• Male
• Middle Aged
• Prognosis
• Prospective Studies
• Severity of Illness Index
• Survival Rate (trends)
• Time Factors
• Young Adult