Prevalence and risk factors of acute-on-chronic liver failure in a single center from Argentina

Abstract

AIMTo study the prevalence, characteristics, risk factors and mortality at 28 d of acute-on-chronic liver failure (ACLF).METHODSA total of 100 cirrhotic patients admitted to our hospital for more than one day were included during the period between June 2013 and December 2015. We used the European Association for the Study of the Liver-Chronic Liver Failure-Consortium diagnostic criteria for ACLF, considering it as the acute decompensation of cirrhosis associated with the presence of one or more organ failure. For the diagnosis of organic failure the Chronic Liver Failure-Sequential Organ Failure Assessment score was used. Our population was divided into patients with and without ACLF. Clinical characteristics, presence of precipitating events, potential risk factors for developing ACLF and causes of mortality were analyzed. Mortality at 28 d was evaluated.RESULTSTwenty-nine patients (29%) developed ACLF criteria. Alcoholism, detected in 58 patients (58%), was the major etiological agent of cirrhosis. Bacterial infections were recognized as a precipitating event in 41.3% of cases and gastrointestinal bleeding in 27.5%. No precipitating event was identifiable in 27.5% of patients with ACLF. Comparing patients with and without ACLF, statistically significant risk factors were: Child Pugh score 10.2 ± 2.1 vs 8.4 ± 1.6 (P ˂ 0.0001), MELD score 20.7 ± 8.5 vs 12.3 ± 4 (P ˂ 0.0001), presence of ascites 27 (93%) vs 43 (60.5%) (P = 0.001), leukocytosis 15300 ± 8033 per cubic millimeter vs 10770 ± 5601 per cubic millimeter (P ˂ 0.0001), and high plasma levels of C reactive protein values 50.9 ± ​​46.4 mg/L vs 28.6 ± 23.4 mg/L (P ˂ 0.0019). Mortality rate was 62% (18 patients) vs 5.6% (4 patients), respectively (P < 0.0001).CONCLUSIONWe observed that the ACLF is a frequent entity in this group of patients and has a significantly higher mortality rate.

Chronic liver failure-consortium acute-on-chronic liver failure and acute decompensation scores predict mortality in Brazilian cirrhotic patients

“…Using the CLIF Consortium definition of ACLF, Soares e Silva et al[ 12 ] also showed that ACLF was a strong predictor of short-term mortality in a Brazilian population. Similar findings were described as well in a recent Argentina study[ 13 ]. However, to the best of our knowledge, the present study is the first to validate CLIF-C AD and CLIF-C ACLF scores outside Europe.…”

Clinical Characteristics and Outcome of Acute on Chronic Liver Failure Patients at Fatmawati General Hospital

“…Epidemiology data on ACLF is still rare; several new studies stated that in the United States, more than 700,000 patients who were hospitalized in a year has a diagnosis of liver cirrhosis and apparently 5% of them can be categorized 6 Bacterial infection and gastrointestinal bleeding are the most common triggers of ACLF. 7 Result of the aforementioned study was in accordance with the data of ACLF aetiologies in Fatmawati General Hospital where most cases were caused by hepatitis B.…”

Chinese Herb Jiedu Huayu Granules Inhibiting Immune and Inflammatory Response of Rats with Acute Liver Failure by Regulating the NF-κB Signaling Pathway

“…At present, more and more scholars agree with “Two-hit theory with immune-inflammatory injury as the core.” That is, on the basis of direct damage to liver cells such as HBV, through lipopolysaccharide- (LPS-) induced core pathogenesis of liver failure (endotoxin-macrophage-cytokine storm), an excessive and long-lasting immune-inflammatory response is produced. This response causes a “second hit” to the liver, ultimately resulting in the occurrence of liver failure [ 17 , 18 ].…”