Dynamic Prognostication in Transplant Candidates with Acute-on-Chronic Liver Failure

Abstract

We aimed to extensively investigate clinical markers that are sufficiently dynamic for prognosis of acute-on-chronic liver failure (ACLF). Defined by the Asian Pacific Association for the Study of the Liver (APASL) criteria, patients with ACLF on the liver transplant waitlist in a tertiary center were retrospectively reviewed. Laboratory results and severity scores at three time points (days 1, 7, and 14 after admission) were analyzed. From 2015 to 2019, 64 patients with ACLF were enrolled, of which 24 received a liver transplant from 22 live donors. The hospital mortality rate was 31% (8% for transplant; 45% for nontransplant groups), and the 3-month survival was crucial for determining long-term outcomes. The number of significant variables for mortality, and, specifically, the hazards of international normalized ratio of prothrombin time (INR) and APASL ACLF Research Consortium (AARC) score were increased within two weeks. In multivariable analysis, INR and AARC score (D-14) were associated with poor survival and liver transplant was a protective factor in all patients, while AARC score (D-14) was significant in the nontransplant group. AARC score at day 14 is an independent risk factor for mortality in ACLF. Liver transplant from live donors reversed poor outcomes in patients with ACLF in a timely manner.

Decreased vitamin D-binding protein level portends poor outcome in acute-on-chronic liver failure caused by hepatitis B virus

“…PT-INR, an indicator of failed liver function, is also a marker for subsequent coagulation failure. Lu et al [ 26 ] recently demonstrated that a gradually increasing PT-INR index was associated with poor survival and indicated the need for fast-track liver transplant. Consistent with that result, the present study found that coagulation failure was also closely correlated with VDBP level when patients were stratified by clinical outcome.…”

Personalized Medicine for Liver Disease: From Molecular Mechanisms to Potential Targeted Therapies

“…The heterogeneity in etiology leads to variable disease courses and has hampered accurate diagnosis and prognosis. Lu et al investigate dynamic changes in clinical markers, especially within the first 2 weeks of clinical admission, that aid in predicting poor prognosis and indicate the necessitation of fast-tracking therapeutic interventions or transplant prioritization [ 9 ].…”