Clinical Course and Outcome Patterns of Acute-on-chronic Liver Failure: A Multicenter Retrospective Cohort Study

Background and Aims: Acute-on-chronic liver failure (ACLF) is acute decompensation of liver function in the setting of chronic liver disease, and characterized by high short-term mortality. In this study, we sought to investi-gate the clinical course of patients at specific time points, and to propose dynamic prognostic criteria. Methods: We assessed the clinical course of 453 patients with ACLF dur -ing a 12-week follow-up period in this retrospective multi-center study. The clinical course of patients was defined as disease recovery, improvement, worsening or steady pat-terns based on the variation tendency in prothrombin activ-ity (PTA) and total bilirubin (TB) at different time points. Results: Resolution of PTA was observed in 231 patients (51%) at 12 weeks after the diagnosis of ACLF. Among the remaining patients, 66 (14.6%) showed improvement and 156 (34.4%) showed a steady or worsening course. In pa-tients with resolved PTA, the clinical course of TB exhibited resolved pattern in 95.2%, improved in 3.9%, and steady or worse in 0.8%. Correspondingly, in patients with im-proved PTA, these values for TB were 28.8%, 27.3%, and 43.9%, respectively. In patients with steady or worsening PTA, these values for TB were 5.7%, 32.3%, and 65.6%, respectively. Dynamic prognostic criteria were developed by combining the clinical course of PTA/TB and the clini-cal outcomes at 4 and 12 weeks after diagnosis in ACLF patients. Conclusions: We propose the following dynamic prognostic criteria: rapid progression, slow progression, rapid recovery, slow recovery, and slow persistence, which lay the foundation for precise prediction of prognosis and the improvement of ACLF therapy. Citation of this article: Xu MM, Kong M, Yu PF, Cao YY, Liu F, Zhu B, et al. Clinical course and outcome patterns of acute-on-chronic liver failure: a multicenter retrospective cohort study. J Clin Transl Hepatol 2021. doi: 10.14218/ JCTH.2020.00179.