Acute-on-Chronic Liver Failure: A Portuguese Single-Center Reference Review

Abstract

Acute-on-chronic liver failure (ACLF) is a syndrome characterized by an acute deterioration of a patient with cirrhosis, frequently associated with multi-organ failure and a high short-term mortality rate. We present a retrospective study that aims to characterize the presentation, evolution, and outcome of patients diagnosed with ACLF at our center over the last 3 years, with a comparative analysis between the group of patients that had ACLF precipitated by infectious insults of bacterial origin and the group of those with ACLF triggered by a nonbacterial infectious insult; the incidence of acute kidney injury and its impact on the prognosis of ACLF was also analyzed. Twenty-nine patients were enrolled, the majority of them being male (89.6%), and the mean age was 53 years. Fourteen patients (48.3%) developed ACLF due to a bacterial infectious event, and 9 of them died (64.2%, overall mortality rate 31%); however, no statistical significance was found (p < 0.7). Of the remaining 15 patients (51.7%) with noninfectious triggers, 11 died (73.3%, overall mortality rate 37.9%); again there was no statistical significance (p < 0.7). Twenty-four patients (83%) developed acute kidney injury (overall mortality rate 65.5%; p < 0.022) at the 28-day and 90-day follow-up. Twelve patients had acute kidney injury requiring renal replacement therapy (41.37%; overall mortality rate 37.9%; p < 0.043). Hepatic transplant was performed in 3 patients, with a 100% survival at the 28-day and 90-day follow-up (p < 0.023). Higher grades of ACLF were associated with increased mortality (p < 0.02; overall mortality 69%). Conclusions: ACLF is a heterogeneous syndrome with a variety of precipitant factors and different grades of extrahepatic involvement. Most cases will have some degree of renal dysfunction, with an increased risk of mortality. Hepatic transplant is an efficient form of therapy for this syndrome.

Intra-abdominal hypertension and abdominal compartment syndrome in the critically ill liver cirrhotic patient–prevalence and clinical outcomes. A multicentric retrospective cohort study in intensive care

“…A high mortality rate was observed and comparable with other studies in critically ill liver cirrhosis patients showing short-term mortality rates ranging from 34.9% to 71.9% [32][33][34].…”

Acute Kidney Injury at Admission Is a Better Predictor of Mortality than Its Persistence at 48 h in Patients with Acute-on-chronic Liver Failure

“…This study was conducted in ACLF patients whose diagnosis was defined according to the APASL definition: “an acute hepatic insult manifesting as jaundice and coagulopathy, complicated within 4 weeks by ascites and/or encephalopathy in a patient with previously diagnosed or undiagnosed chronic liver disease” 12. Data were collected prospectively from in-patients admitted to the Gastroenterology Department, Sriram Chandra Bhanja Medical College between October 2016 and February 2018.…”

The fibrogenic process and the unleashing of acute-on-chronic liver failure

“…However, biliary nephropathy is an important toxic injury caused by elevated levels of bile acids and bilirubin, which is significantly common in patients with ACLF. 22 In addition, the number of organic failures is also correlated with http://www.e-cmh.org https://doi.org/10.3350/cmh.2019.0011 mortality, increasing abruptly when there are more than two organic failures to 80% and increase up to 94% when there are more than 3 and 4 organic failures. 28 Among the available forecast scores, CLIF-C ACLF and Acute Physiology and Chronic Health Evaluation (APACHE) II present the best performance.…”