Clinical Course and Outcome Patterns of Acute-on-chronic Liver Failure: A Multicenter Retrospective Cohort Study

Abstract

Background and Aims: Acute-on-chronic liver failure (ACLF) is acute decompensation of liver function in the setting of chronic liver disease, and characterized by high short-term mortality. In this study, we sought to investigate the clinical course of patients at specific time points, and to propose dynamic prognostic criteria. Methods: We assessed the clinical course of 453 patients with ACLF during a 12-week follow-up period in this retrospective multicenter study. The clinical course of patients was defined as disease recovery, improvement, worsening or steady patterns based on the variation tendency in prothrombin activity (PTA) and total bilirubin (TB) at different time points. Results: Resolution of PTA was observed in 231 patients (51%) at 12 weeks after the diagnosis of ACLF. Among the remaining patients, 66 (14.6%) showed improvement and 156 (34.4%) showed a steady or worsening course. In patients with resolved PTA, the clinical course of TB exhibited resolved pattern in 95.2%, improved in 3.9%, and steady or worse in 0.8%. Correspondingly, in patients with improved PTA, these values for TB were 28.8%, 27.3%, and 43.9%, respectively. In patients with steady or worsening PTA, these values for TB were 5.7%, 32.3%, and 65.6%, respectively. Dynamic prognostic criteria were developed by combining the clinical course of PTA/TB and the clinical outcomes at 4 and 12 weeks after diagnosis in ACLF patients. Conclusions: We propose the following dynamic prognostic criteria: rapid progression, slow progression, rapid recovery, slow recovery, and slow persistence, which lay the foundation for precise prediction of prognosis and the improvement of ACLF therapy.

Comparative analysis of monocyte-derived dendritic cell phenotype and T cell stimulatory function in patients with acute-on-chronic liver failure with different clinical parameters

“…Prothrombin activity is one of the indicators used to assess clotting function ( 1 ). In patients with acute-on-chronic liver failure, there is a correlation between prothrombin activity, infection, and poor prognosis ( 41 – 43 ). While prothrombin activity is primarily used to assess clotting function, there is extensive interaction between the clotting system and the immune system ( 44 ).…”

Acute decompensation of cirrhosis versus acute‐on‐chronic liver failure: What are the clinical implications?

“…In its princep study, daily calculation of the APASL ACLF research consortium (AARC) score during the first week showed mortality risk associated with score increments, especially with values exceeding 10 25 . Bilirubin and INR, demonstrated trends over time that aided in identifying different clinical courses, including rapid progression, slow progression, rapid recovery, slow recovery, and slow persistence accounting respectively for 25.6%, 16.8%, 30.2%, 18.3% and 9.1% of patients 26 . Overall, sequential evaluation of ACLF grades over time is essential to accurately adapt clinical management, as approximately 40%–50% of patients exhibit improvement or resolution, while others experience steady or worsening trajectories.…”

“… 25 Bilirubin and INR, demonstrated trends over time that aided in identifying different clinical courses, including rapid progression, slow progression, rapid recovery, slow recovery, and slow persistence accounting respectively for 25.6%, 16.8%, 30.2%, 18.3% and 9.1% of patients. 26 Overall, sequential evaluation of ACLF grades over time is essential to accurately adapt clinical management, as approximately 40%–50% of patients exhibit improvement or resolution, while others experience steady or worsening trajectories. The dynamic evaluation of EASL‐ACLF assists in identifying the population that necessitates prompt decision‐making regarding LT or the limitation of care.…”

Clinical application of artificial liver and blood purification: expert consensus recommendations

“…The timing of artificial liver treatment is determined in conjunction with various factors such as the pathophysiological characteristics of the disease, indication for artificial liver model, and the treatment objectives for the patient, in line with the "early diagnosis and early treatment" principle [5,6].…”