Predictors of early mortality among patients with acute‐on‐chronic liver failure

Abstract

Background and Aim: Acute-on-chronic liver failure (ACLF) is a transpiring entity, which possesses high short-term/early mortality (28 days). Several mortality predictors have been studied, but none were proved reliable. Serum ferritin, an acute phase reactant and marker of hepatic necro-inflammation, is found to predict mortality in multiple liver diseases. We aimed to evaluate the role of serum ferritin and other clinical features, biochemical parameters and conventional scoring systems in predicting early mortality among ACLF. Methods: A prospective cohort study was done from October 2017 to March 2019 at a tertiary care (non-transplant) center in eastern India. A total of consecutive 50 ACLF patients diagnosed, based on Asia Pacific Association for the Study of liver disease definition, were investigated for ferritin and other laboratory parameters on day-0, day-7, and followed up for 28 days. Results: Although the majority did not have organ failure (ACLF grade 0) according to European Association for Study of Liver-chronic liver failure sequential organ failure assessment criteria, early mortality was high (56%). On undergoing univariate analysis, multiple variables (ascites, HE, creatinine, total leucocyte count (TLC), bilirubin, albumin) predicted mortality. However, on multivariate analysis, only total bilirubin independently predicted. None of the scores on day-0 were predictive, while model for end-stage liver disease [area under the receiver operating characteristics (AUROC)-0.703, 95% confidence interval [CI]: 0.535-0.859] and Child-Turcotte-Pugh (AUROC-0.697, 95% CI: 0.550-0.855) on day-7 did. Conclusion: ACLF is a dynamic process; day-7 assessment with above predictors, to be considered a milestone for prognostication and opting treatment modalities. Serum ferritin does not predict early mortality in ACLF.

Implications of Gender on the Outcome in Patients With Autoimmune Hepatitis

“…No patient developed HCC in our study. Patients who presented with AIH-ACLF and AS-AIH had a higher mortality corresponding to previous reports [ 25 , 26 ].…”

The value of dynamic changes in FT3 level for predicting 90-day prognosis of HBV-ACLF patients

“…The study considers these differences to assess the generalisability of the findings to a broader patient population. Scholars recognise that the mortality rate of this disease is high [ 2 ], exceeding 50% [ 3 ]. Hepatitis B virus–related ACLF is the most important type of ACLF in China [ 4 ], accounting for approximately 80% of ACLF, with a high fatality rate of 60–80% [ 5 , 6 ].…”