Abstract
Background
Acute-on-chronic liver failure (ACLF) is an entity comprising an acute deterioration
of liver function in cirrhotic patients, associated with organ failure(s) and high
short-term mortality. We aimed to identify predictive factors for short-term mortality
in patients admitted with ACLF that may benefit most from liver transplantation.
Methods
Retrospective analysis of patients admitted in ACLF to a tertiary intensive care unit
between 2013 and 2017 was performed. The EASL-CLIF acute-on-chronic liver failure
in cirrhosis (CANONIC) criteria were used to define ACLF grade. Multivariable analysis
using 28-day mortality as an end-point was performed, including severity-of-disease
scores and clinical parameters.
Results
Seventy-seven patients were admitted in ACLF over the study period. The commonest
aetiology of liver disease was alcohol related 52/77(68%) and the commonest precipitant
of ACLF was variceal haemorrhage 38/77(49%). Overall 28-day mortality was 42/77(55%)
[ACLF-(grade)1:3/42(7%); ACLF-2:10/42(24%); and, ACLF-3:29/42(69%);p = 0.002]. On multivariable analysis MELD ≥ 26 [odds ratio(OR) = 11.559; 95% confidence
interval(CI):2.820–47.382;p = 0.001], ACLF-3 (OR = 3.287; 95%CI:1.047–10.325;p = 0.042) at admission and requirement for renal replacement therapy (OR = 5.348;
95%CI:1.385–20.645;p = 0.015) were independently associated with 28-day mortality.
Conclusion
Patients admitted with ACLF to intensive care have a high mortality rate. Defined
early thresholds at admission can identify patients at the highest risk that may benefit
most from liver transplantation.
Keywords
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Article info
Publication history
Published online: May 04, 2019
Accepted:
April 9,
2019
Received:
November 20,
2018
Identification
Copyright
Crown Copyright © 2019 Published by Elsevier Ltd on behalf of Editrice Gastroenterologica Italiana S.r.l. All rights reserved.
