Global burden of disease: acute-on-chronic liver failure, a systematic review and meta-analysis

Abstract

Background and aimsAcute-on-chronic liver failure (ACLF) is characterised by acute decompensation of cirrhosis associated with organ failures. We systematically evaluated the geographical variations of ACLF across the world in terms of prevalence, mortality, aetiology of chronic liver disease (CLD), triggers and organ failures.MethodsWe searched EMBASE and PubMed from 3/1/2013 to 7/3/2020 using the ACLF-EASL-CLIF (European Association for the Study of the Liver-Chronic Liver Failure) criteria. Two investigators independently conducted the abstract selection/abstraction of the aetiology of CLD, triggers, organ failures and prevalence/mortality by presence/grade of ACLF. We grouped countries into Europe, East/South Asia and North/South America. We calculated the pooled proportions, evaluated the methodological quality using the Newcastle-Ottawa Scale and statistical heterogeneity, and performed sensitivity analyses.ResultsWe identified 2369 studies; 30 cohort studies met our inclusion criteria (43 206 patients with ACLF and 140 835 without ACLF). The global prevalence of ACLF among patients admitted with decompensated cirrhosis was 35% (95% CI 33% to 38%), highest in South Asia at 65%. The global 90-day mortality was 58% (95% CI 51% to 64%), highest in South America at 73%. Alcohol was the most frequently reported aetiology of underlying CLD (45%, 95% CI 41 to 50). Infection was the most frequent trigger (35%) and kidney dysfunction the most common organ failure (49%). Sensitivity analyses showed regional estimates grossly unchanged for high-quality studies. Type of design, country health index, underlying CLD and triggers explained the variation in estimates.ConclusionsThe global prevalence and mortality of ACLF are high. Region-specific variations could be explained by the type of triggers/aetiology of CLD or grade. Health systems will need to tailor early recognition and treatment of ACLF based on region-specific data.

Universal definition and prognostication in acute-on-chronic liver failure – an unmet need!

“…Such discordance might be due to inappropriate exclusions or presence of liver or coagulation failure among study population (2). These findings are not in line with previously published data which report renal failure to be the most common OF in ACLF (6). Also, it was strange to note that 18.6% patients with grade-III EASL-ACLF did not have any OF by NACSELD criteria.…”

Acute-on-chronic liver failure: a global disease

“…Martin Schulz, 1 Jonel Trebicka 1,2 Acute-on-chronic liver failure (ACLF) is a frequent complication in hospitalised patients with liver cirrhosis. A large body of data has been published in recent years, demonstrating that acute decompensation constitutes a dramatic turning point in the course of cirrhosis, with development of ACLF being the most severe form of acute decompensation (AD).…”

The impact of recipient age on the effects of umbilical cord mesenchymal stem cells on HBV-related acute-on-chronic liver failure and liver cirrhosis

“…Acute-on-chronic liver failure (ACLF) remains a global health concern. The latest research confirms that the global prevalence and mortality rate of ACLF are high, and the global prevalence of ACLF among patients admitted with decompensated cirrhosis was 35%; its prevalence is highest in South Asia (65%) [ 1 ]. Hepatitis B virus (HBV) infection is the most common cause of ACLF and cirrhosis.…”