A study of clinical profile in patients with acute on chronic liver failure in a teritary hospital

Kumar, Brijesh; Rahul, D; Prabhakar, B.

doi:10.21276/apjhs.2016.3.2.10

Cited by 3 publications

(6 citation statements)

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“…Hepatic encephalopathy, low serum Sodium and high INR were found to be independent baseline predictors of mortality on multivariate analysis which was similar to other studies. 26,35 Occurrence of multi organ failure especially with 3 or more failures resulted in a very bad prognosis causing almost 90% mortality in all patients and this is in concordance to findings in other studies in critically ill patients. 36…”

Section: Discussionsupporting

confidence: 86%

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A study of clinical profile and factors affecting mortality in patients with acute on chronic liver failure in a tertiary hospital in north east India

et al. 2021

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Background: Data regarding Acute on Chronic Liver Failure (ACLF) patients from North East India is scarce and presentation to hospital is often late. We aim to study their clinical profile, aetiology of underlying chronic liver disease, precipitating factors, predictors of mortality and their short term outcome (3 months).Methods: Among 1000 consecutive patients of any form of acute decompensation, 245 patients diagnosed as ACLF were prospectively studied. Comparison was done between survivors versus non survivors of ACLF and between ACLF and Non ACLF patients.Results: Mean age of ACLF patients was 44.2±10.3 years and male:female ratio was 13.4:1. Common causes of underlying cirrhosis in ACLF was alcoholic liver disease, 210 (85.7%), Hepatitis B virus related cirrhosis, 20 (8.2%), Hepatitis C virus related cirrhosis, 6 (2.4%) and cryptogenic in 8 (3.3%). Precipitating causes were alcoholic hepatitis in 98 (46.6%) among alcoholic cirrhosis, acute flare of Hepatitis B infection in 12 patients (60%) among Hepatitis B related cirrhosis, recent use of drugs in 110 (44.8%), sepsis in 71 (28.9%), spontaneous bacterial peritonitis (SBP) in 36 (14.7%), urinary tract infection in 36 (14.7%), acute hepatitis A in 5 (2%) and acute hepatitis E in 3 (1.2%). hepatic encephalopathy, low sodium, high International Normalised Ratio (INR) were found to be significantly associated with high mortality. Increasing number of organ failures is associated with increasing risk of death.Conclusions: ACLF is characterized by rapid deterioration especially when multiorgan failure sets in due to certain precipitating factors in a previously diagnosed or undiagnosed chronic liver disease.

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Section: Discussionsupporting

confidence: 86%

“…Infection was documented in only 24% patients. Kumar et al (2016) showed similar findings of 32% patients with sepsis in their study. 34 High mortality was seen in our patients, (67.5%) 90 day mortality.…”

Section: Discussionsupporting

confidence: 81%

A study of clinical profile and factors affecting mortality in patients with acute on chronic liver failure in a tertiary hospital in north east India

et al. 2021

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“…Acute-on-chronic liver failure (ACLF) is a clinical syndrome of sudden hepatic decompensation in patients with pre-existing chronic liver disease that is associated with one or more extra-hepatic organ failures and increased mortality [1]. ACLF is characterized by a rapidly deteriorating course in a previously diagnosed or undiagnosed chronic liver disease with a potential for reversibility [2].…”

Section: Introductionmentioning

confidence: 99%

Clinical profile and outcome among patients with acute-on-chronic liver failure admitted in the intensive care unit

Sayed¹,

Gouda

Khalil

et al. 2021

Egypt J Intern Med

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Background Acute-on-chronic liver failure (ACLF) has been recently defined as a clinical form including acute hepatic decompensation and high 28-day mortality. ACLF usually follows a precipitating event on the background of established cirrhosis. ACLF is considered the most frequent indication for admission to the ICU among cirrhotic patients. Our research aimed to reveal the clinical profile and outcome among patients with ACLF to detect an allocation system of these patients to the intensive care unit (ICU), and a decision tool for clinical practice. It is a prospective study of 60 patients with ACLF. Patients are divided into group A that included 30 patients with ACLF admitted to the hepatology and gastroenterology ward and group B that also included 30 patients with ACLF admitted to the ICU. Each group is subdivided into subgroups regarding the grade of ACLF. Results The most common precipitating factor of ACLF is SBP 78.3% (80% in ICU, 73.6% inward). Renal failure is the most common organ failure in ACLF in both groups. CLIF-C ACLF is assumed to be a highly prognostic score for mortality in ACLF patients better than other scores. ROC curve of CLIF-C ACLF with AUC: 0.972 and CI: 0.919, 1.025 showed a cutoff point = 57.0 above which intensive care admission does not seem to benefit ACLF patients. The sensitivity at the optimal cut point is 88.89% and the specificity is 100%. There is a significant difference between the 3 ACLF groups regarding 1-month and 3-month mortalities in patients admitted to the ICU. ACLF1 shows the least 1-month and 3-month mortality rates while ACLF3 shows the highest mortality rates in ICU patients ((1-month mortality: 20%, 60%, 100% in ACLF1, 2, 3 respectively), (3-month mortality: 50%, 80%, 100% in ACLF1, 2, 3 respectively)). Conclusion Mortality is high in ACLF and increases with the number of organ failures (40% in ACLF1 to 100% in ACLF3). CLIFC-ACLF is the most prognostic scoring system with a cut-off value of 57; above this value, mortality is a fact.

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“…Tasneem et al (2017) [ 7 ] highlighted CTP Score (p = 0.010, OR = 4.286), MELD Score (p = 0.001, OR = 6.222), Albumin (p = 0.116, OR = 2.708), and INR (p = 0.075, OR = 2.585). Kumar et al (2016) [ 20 ] noted significant differences in Prothrombin Time, INR, Creatinine, AST, s/bilirubin, Sodium, and ALT. Kulkarni et al (2018) [ 16 ] found Sodium, Potassium, Creatinine, Hemoglobin, and INR to be significant.…”

Section: Discussionmentioning

confidence: 99%

“…Comparable trends are evident in the previous literature, with higher ACLF grades correlating with increased mortality [ 16 - 18 ]. Kumar et al (2016) [ 20 ] reported mortality rates of 90% with three or more organ failures. Similarly, Reddy et al (2021) [ 12 ] also observed significantly greater mortality in Type C ACLF.…”

Section: Discussionmentioning

confidence: 99%

Acute-on-Chronic Liver Failure: Causes, Clinical Parameters, and Predictors of Mortality

Hafsa,

Chaudary,

Tariq

et al. 2024

Cureus

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Objectives This study aimed to identify the causes, clinical characteristics, and 28-day in-hospital mortality predictors in patients with acute-on-chronic liver failure (ACLF). Methods A cross-sectional study enrolled sixty-four patients aged 18-70 years with acute-on-chronic liver failure. The study was conducted at the Gastroenterology Department, Lahore General Hospital. The study classified ACLF according to the criteria of the European Association for the Study of the Liver - Chronic Liver Failure (EASL-CLIF). Patients were followed for 28 days for mortality outcomes. The outcomes between Survivor and Non-survivor groups were compared using the Chi-Square/Fisher's Exact Test for categorical variables and the Mann-Whitney U test for continuous variables. Results In this study, age and duration of chronic liver disease were not significantly different between survivors and non-survivors. The etiology of liver disease and ACLF causes had no impact on 28-day mortality. Non-survivors had lower mean arterial pressure, and higher mortality was linked with lower Glasgow Coma Scale scores, upper gastrointestinal bleeding, and Grade IV hepatic encephalopathy. Significant differences in bilirubin, serum creatinine, urea, and C-reactive protein levels were observed at 28 days. Survival rates were highest with single organ failure (35.94%) and decreased with multiple organ failures. The overall survival rate was 51.56%. Predictive validity for mortality was assessed using the Area Under the Curve (AUC), with Child-Turcotte-Pugh (CTP) at 0.679, Model for End-Stage Liver Disease (MELD) at 0.819, and Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) at 0.771. Conclusion This study concludes that in acute-on-chronic liver failure, factors like age, gender, and disease etiology do not significantly predict 28-day mortality. Key mortality indicators include clinical parameters such as lower Glasgow Coma Scale scores, hepatic encephalopathy Grade IV, and laboratory findings like elevated bilirubin and serum creatinine. The MELD score is the most compelling prognostic tool.

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A study of clinical profile in patients with acute on chronic liver failure in a teritary hospital

Cited by 3 publications

References 0 publications

A study of clinical profile and factors affecting mortality in patients with acute on chronic liver failure in a tertiary hospital in north east India

A study of clinical profile and factors affecting mortality in patients with acute on chronic liver failure in a tertiary hospital in north east India

Clinical profile and outcome among patients with acute-on-chronic liver failure admitted in the intensive care unit

Acute-on-Chronic Liver Failure: Causes, Clinical Parameters, and Predictors of Mortality

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