Type of Hepatic Decompensation in a Hospitalized Cirrhotic Patient Predicts the Onset of ACLF and Mortality: 486

Introduction: Acute or chronic liver failure (ACLF) has been recognized as an major cause of mortality in cirrhotic patients admitted to hospital with hepatic decompensation. Identification of factors that predict ACLF and mortality in these patients is of utmost importance. Methods: The study involved retrospective chart review of 198 randomly selected patients out of 860 admitted to a tertiary medical center between January 2010 and June 2013. We collected variables including age, gender, race, etiology of cirrhosis, type of decompensation at admission, infection, organ failure (renal failure-serum creatinine >=2.0mg/dL; liver failure - total bilirubin>5mg/dL; cerebral failure - grade 3/4 encephalopathy; circulatory failure - on pressors; coagulation failure - INR>2.5; respiratory failure-mechanical ventilation) during the index hospital admission and dates of death. Patients <18, prior solid organ transplant, diagnosis of hepatocellular carcinoma, and those admitted to the hospital without decompensation were excluded from the study. The study population was divided into ACLF and non-ACLF groups, depending on whether they had organ failure. Results: Eighty-five of the 198 met the study criteria, including 52 with ACLF and 33 non-ACLF. Prevalence of ACLF among the cirrhotic patients admitted to the hospital was 26%. Overall mortality(for all hospital admissions) was higher in patients with ACLF vs. non-ACLF (p=0.02; odds ratio [OR] 3.22; confidence interval [CI] 1.13-9.17). Among all the participants, mortality due to ACLF was 34%. Fifty percent of the patients with ACLF died in the first 2 months after index hospital admission (IQR=0.31-23.79). Gender and etiology of cirrhosis had no influence on the prevalence of ACLF or mortality. Patients with ACLF were younger (54.8 vs. 60.61; p=0.02) but no difference was seen with mortality. Patients with ascites were more likely to develop ACLF (p=<0.001; OR 11.18; CI 3.95-31.66). No such significance was observed in patients with infection, variceal bleeding, or encephalopathy. Patients admitted with infection had higher mortality than those without (p=0.001;OR 6.00;CI 1.91-18.85). Similar findings were seen in those admitted with ascites (p =<0.043;OR 3.32; CI 1.00-11.07). Highest mortality was observed in patients admitted with ascites and infection (p=0.01; OR=10.62; CI 2.05-54.95). Mortality rates were similar between patients with and without variceal bleeding or encephalopathy. Conclusion: Cirrhotic patients admitted with ascites were at a significantly higher risk of developing organ failure/ACLF than those without ascites. Patients admitted with ascites and infection had a significantly higher mortality than those with other forms of hepatic decompensation. Further studies are needed to identify means to reduce the risk of mortality in this high risk population.