Abstract
Background
Few studies have evaluated whether combination and sequential evaluation of ACLF (acute-on-chronic
liver failure) and hyponatremia aids prognosis.
Aims
Describe clinical course and determine prognostic capability of assessing ACLF and
hyponatremia at specific time-points.
Methods
Prospective study with inclusion of 376 patients. ACLF and hyponatremia were evaluated
at days 1 and 7 and classified as persistent, transient, de novo or absent. Follow-up was 90 days.
Results
At inclusion, ACLF was diagnosed in 99 patients. Reversal was observed in 57 patients
and was associated with lower creatinine and ACLF grade. De novo ACLF developed in 19 patients, and MELD (model of end-stage liver disease) score
and lower albumin were predictive factors. Hyponatremia was present in 76 patients
(persistent, transient and de novo in 27, 24 and 25 respectively). ACLF at D7 had the lowest survival compared to transient
or no ACLF (21, 57 and 80%, p < 0.0001). Hyponatremia at admission was associated with low survival (35%) whereas
survival was higher for de novo or absent cases (70%), p < 0.001. In multivariate analysis ACLF at D7 and hyponatremia at D1 were predictors
of survival.
Conclusion
ACLF and hyponatremia are dynamic and evaluation of both conditions at different time-points
identifies patients at higher risk of short-term mortality.
Keywords
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Article info
Publication history
Published online: September 18, 2019
Accepted:
August 1,
2019
Received:
March 1,
2019
Identification
Copyright
© 2019 Editrice Gastroenterologica Italiana S.r.l. Published by Elsevier Ltd. All rights reserved.
