Population-representative Incidence of Acute-On-Chronic Liver Failure

Abstract

Background:Acute-on-chronic liver failure (ACLF) is a major cause of hepatic death in the world, but no population-based studies have evaluated the incidence of ACLF. This study was conducted to determine the incidence and short-term outcomes of ACLF in a region of Eastern China.Methods:In this prospective cross-sectional study, we collected data from public hospitals in Nantong city between January 1, 2005, and December 31, 2014. All hospitals with admission potential for ACLF patients were included. The primary outcome was ACLF defined as severe jaundice and coagulopathy with underlying chronic liver disease, according to diagnostic and laboratory criteria suggested by Chinese Society for Hepatology (CSH).Results:During the 10-year period, a consecutive sample of 1934 ACLF patients was included in this study. The overall ACLF incidence rate over the 10-year period was 2.53 (95% confidence interval, 2.16-2.91) per 100,000 population per year, decreasing from 3.35 in 2005 to 2.06 in 2014. Chronic hepatitis B virus (HBV) infection was the leading cause of chronic liver disease and HBV reactivation was the most common cause of acute hepatic event. The 28-day mortality for the ACLF patients had a clear decline during the study period, form 50.39% in 2005 to 35.44% in 2014.Conclusions:In the Eastern China population, the incidence of ACLF is decreasing and the prognosis improving. Short-term mortality was associated with the presence of cirrhosis and growing age. While ACLF remains a life-threatening disorder, our findings suggest that nationwide and long-term cohorts should be conducted for the natural history of ACLF.

Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update

“…Data from the West is lacking on drugs as an acute insult leading to ACLF. In Asia 1.8% [42] to 5.7% [43,44] precipitating events for ACLF are related to drugs. In Chinese cohort, the drugs were mostly from herbal or traditional medications to anti tuberculosis drugs in Indian cohorts [44].…”

Plasma microRNA: A novel non‑invasive biomarker for HBV‑associated liver fibrosis staging

“…There are several other factors that cause liver disease, including viruses, bacteria, parasites, other infectious factors and non-infectious factors, including alcohol, drugs, autoimmune disease, metabolic syndromes, genetic defects and congenital dysplasia. HBV is the most common cause of liver fibrosis in China (1). A previous study hypothesized that the clinical pathway of the majority of HBV-associated HCC follows four stages: Healthy; hepatitis; cirrhosis; and HCC (22).…”

“…According to the Chinese Society of Hepatology, the most common cause of liver fibrosis is chronic viral hepatitis B (CHB) infection (1). Globally, 30% of cirrhosis cases are caused by hepatitis B virus (HBV) (2).…”

Differential characteristics and prognosis of patients with hepatitis B virus‐related acute‐on‐chronic liver failure defined by European Association for the Study of the Liver – Chronic Liver Failure criteria

“…Furthermore, in this APASL‐ACLF cohort, bacterial infection was the main precipitating event of ACLF, which was incongruent with the finding that, in most APASL‐ACLF patients, the acute insult is precipitated by hepatitis B virus (HBV) reactivation. In China, HBV‐related ACLF accounts for 87.3–91% of all ACLF cases . Therefore, we undertook this study to investigate the usefulness of the EASL‐CLIF classification in patients with HBV‐related APASL‐ACLF by carrying out an in‐depth analysis of the clinical characteristics, disease progression, and associated risk factors.…”

“…In China, HBV-related ACLF accounts for 87.3-91% of all ACLF cases. 14,15 Therefore, we undertook this study to investigate the usefulness of the EASL-CLIF classification in patients with HBV-related APASL-ACLF by carrying out an in-depth analysis of the clinical characteristics, disease progression, and associated risk factors. We also evaluated the prognostic accuracy of the CLIF-C ACLFs compared with classical prognostic scores in patients with HBV-related APASL-ACLF.…”