Clinical Profile and Outcome in Acute on Chronic Liver Failure (ACLF)

Background and Aims: ACLF is defined as an acute deterioration of liver function in a patient with previously fairly well-compensated chronic liver disease. The aims of this study were to understand the natural history, etiology of acute insult and underlying chronic liver disease, prognostic outcome, and whether there was any subgroup of chronic liver disease which had a higher rate of decompensation.Materials and Methods: This was a prospective study conducted in the Gastroenterology department, Institute of Medical Sciences, BHU, Varanasi from December 2013 to November 2014. Data including demographics, clinical presentation, hospital course and outcome of 86 patients were recorded. The etiologies of superimposed acute event and chronic liver disease were investigated on the basis of routine investigations, viral markers, autoimmune markers, Wilson disease panel, serum ferritin and liver biopsy (if feasible). Study variables like coagulopathy, hepatic encephalopathy, sepsis, hyponatremia, renal failure, hepatorenal syndrome and various prognostic scores were considered.Results: Most of the patients were young adults (55%) and males were more common than females (M:F = 2.7:1). The most common presenting features were coagulopathy and ascites (95%) whereas encephalopathy (28%) and GI bleed were less common. The most common cause of acute insult leading to ACLF was hepatotropic viruses (about 50%). About 2/3rd of the patients had CTP-C status at the time of admission. Sepsis (20%), renal failure (13%), and SBP were common complications. At 3 months, the survival of patients with MELD <26 and >26 was 82% and 31%, respectively (Fig. 1 and Table 1).Table 1Comparison of Hematological and Biochemical Parameters between Survivors and Nonsurvivors.VariableSurvivors (n = 45)Nonsurvivors (n = 36)P-valueTLC (×109/L, median, Q1–Q3)8.4 (3.2–18.9)15.0 (2.5–37.2)<0.0001Total bilirubin (mg/dl, mean ± SD)17.7 ± 9.822.6 ± 9.80.02ALT (IU/L, median, Q1–Q3)143 (73–387)163 (79–257)NSSerum albumin (g/dl, mean ± SD)2.96 ± 0.672.65 ± 0.430.01INR (mean ± SD)1.76 ± 0.432.57 ± 0.91<0.01Serum creatinine (mg/dl, mean ± SD)0.8 ± 0.321.7 ± 1.3<0.0001 Open table in a new tab Conclusion: Most of the 86 patients with ACLF were young adult males, with ascites and coagulopathy being the most common presentation. The acute insult was primarily due to hepatotropic viruses whereas chronic was due to HBV infection. SOFA was found to be an independent predictor of mortality whereas MELD had better accuracy in predicting short-term survival. Background and Aims: ACLF is defined as an acute deterioration of liver function in a patient with previously fairly well-compensated chronic liver disease. The aims of this study were to understand the natural history, etiology of acute insult and underlying chronic liver disease, prognostic outcome, and whether there was any subgroup of chronic liver disease which had a higher rate of decompensation. Materials and Methods: This was a prospective study conducted in the Gastroenterology department, Institute of Medical Sciences, BHU, Varanasi from December 2013 to November 2014. Data including demographics, clinical presentation, hospital course and outcome of 86 patients were recorded. The etiologies of superimposed acute event and chronic liver disease were investigated on the basis of routine investigations, viral markers, autoimmune markers, Wilson disease panel, serum ferritin and liver biopsy (if feasible). Study variables like coagulopathy, hepatic encephalopathy, sepsis, hyponatremia, renal failure, hepatorenal syndrome and various prognostic scores were considered. Results: Most of the patients were young adults (55%) and males were more common than females (M:F = 2.7:1). The most common presenting features were coagulopathy and ascites (95%) whereas encephalopathy (28%) and GI bleed were less common. The most common cause of acute insult leading to ACLF was hepatotropic viruses (about 50%). About 2/3rd of the patients had CTP-C status at the time of admission. Sepsis (20%), renal failure (13%), and SBP were common complications. At 3 months, the survival of patients with MELD <26 and >26 was 82% and 31%, respectively (Fig. 1 and Table 1). Conclusion: Most of the 86 patients with ACLF were young adult males, with ascites and coagulopathy being the most common presentation. The acute insult was primarily due to hepatotropic viruses whereas chronic was due to HBV infection. SOFA was found to be an independent predictor of mortality whereas MELD had better accuracy in predicting short-term survival.