Issue: February 2021
Disclosures: Hernaez reports no relevant financial disclosures. Please see the full study for all other relevant financial disclosures.
January 13, 2021
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Acute-on-chronic liver failure has high global prevalence

Issue: February 2021
Disclosures: Hernaez reports no relevant financial disclosures. Please see the full study for all other relevant financial disclosures.
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Nearly one in four patients admitted for decompensated cirrhosis globally have acute-on-chronic liver failure, according to study results.

Ruben Hernaez, MD, MPH, PhD, of Baylor College of Medicine, and colleagues wrote that it has been difficult to predict the worldwide prevalence and outcomes of patients with ACLF because there is no widely accepted definition for the condition.

“Global data on the prevalence and mortality of ACLF are lacking,” they wrote. “It is also unknown whether there are certain geographical variations in the prevalence and mortality across the world and if differences in underlying disease etiologies and precipitating factors may impact ACLF outcomes.”

Researchers conducted a systematic review and meta-analysis to find the global prevalence and mortality of ACLF using a consistent definition, the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) criteria. They searched the literature for reports on etiology of chronic liver disease, triggers, organ failures and prevalence and mortality of ACLF by presence or grade.

Investigators identified 2,369 studies and 30 cohort studies comprising 43,205 patients with ACLF and 140,835 without who fit their criteria. They found that the global prevalence of ACLF among patients admitted for decompensated cirrhosis was 35% (95% CI, 33%-38%). The region with the highest prevalence was South Asia at 65%, followed by Europe at 39%.

The global 90-day mortality was 58% (95% CI, 51%-64%), with South America having the highest rate (73%), followed by South Asia (68%).

Hernaez and colleagues found that the most common etiology of CLD was alcohol (45%), the most common trigger was infection (35%), and the most common organ failure was kidney dysfunction (49%).

“Our systematic review and meta-analysis highlights that ACLF is a global epidemic in hospitalized patients with decompensated cirrhosis and consistently shows high short-term mortality across the world,” they wrote. “National liver societies should create ACLF guidelines to identify and treat accordingly such a significant clinical problem.”