Results from an observational prospective study presented at the International Liver Congress in Barcelona, Spain, may provide diagnostic criteria and prognosis for patients with acute-on-chronic liver failure.
Researchers evaluated 1,379 patients with cirrhosis admitted to 29 hospitals throughout Europe between Feb. 1 and Aug. 15, 2011. The results of 920 cases were reported at the meeting.
Within the initial cohort, 22.6% of patients had acute-on-chronic liver failure (ACLF), which investigators identified according to the following grades:
- ACLF-1: Renal or nonrenal organ failure associated with creatine levels of 1.5 mg/dL to2 mg/dL and/or encephalopathy of grade I-II
- ACLF-2: Two organ failures
- ACLF-3: Three organ failures
- ACLF-4: Four to six organ failures
Common organ failures among participants included liver (15.2%), kidney (12.8%), coagulation (7.7%), circulation (7.0%), brain (4.7%) and lungs (2.2%).
The 28-day mortality rate among all patients with ACLF was 35.3%, including 23.2%, 35.8%, 64.3% and 85.7% from groups 1 to 4, as opposed to a 4.1% mortality rate among patients without ACLF. A significant association was observed between ACLF development and the presence of bacterial infections and active alcoholism, and researchers also noted that the condition was common among patients with previously compensated cirrhosis (21%) and those with cirrhosis decompensated within three months (18%). Events precipitating the condition included hepatitis, paracentesis without albumin and surgery, but these were infrequent within the cohort, and 20% of cases had no precipitating event.
“ACLF is a distinct syndrome characterized by extrahepatic organ failure(s) leading to a high short-term mortality, which depends on the number of failing organs as defined by the [Chronic Liver Failure–Sequential Organ Failure Assessment] score,” the researchers wrote. “It not only develops in previously decompensated, but also in compensated or early decompensated cirrhosis ... [and] is related to systemic inflammatory reaction due to bacterial infection, alcoholic injury or other as-yet unidentified mechanisms.”
For more information:
Moreau R. Abstract #1404. Presented at: The International Liver Congress, April 18-22, Barcelona, Spain.