Acute‐on‐chronic liver failure in India: The Indian National Association for Study of the Liver consortium experience

Abstract

Alcohol was the commonest etiology of ACLF. Within a mean hospital stay of 8 days, 42% patients died. OFs independently predicted survival.

Need for hepatitis A prevention in patients with chronic liver disease in the changing epidemiological setting of India

“…42 Patients with CLD are at increased risk of severe HAV disease [13][14][15]17 and ACLF, which has a very high mortality rate. 16,29,32,44,45 Hence, such patients are recommended to receive various vaccinations, including HAV vaccination, in the US, 20 the UK, 21 and Sri Lanka. 75 Old studies from India showed a high seroprevalence of protective HAV antibodies among Indian adults with CLD, [25][26][27][28]30,31,[46][47][48] although the most recent ones (≤2007) found that nearly 7% of CLD patients did not have protective HAV antibodies and were therefore susceptible to HAV infection.…”

“…32 In another retrospective study, which included 1049 consecutive patients with ACLF (mean age 44.7 ± 12.2 years; 81.3% male) conducted in 10 tertiary centers from across India during 2011-2014, the most common precipitants of ACLF were alcohol consumption (35.7%), viral superinfection/flare (HAV, HBV, or HEV) (21.4%), and sepsis (16.6%). 29 The underlying CLD was mainly alcohol (56.7%), cryptogenic (19.4%), or HBV/ HCV (15.9%). During a median (range) hospital stay of 8 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days, 42.6% of patients died.…”

“…23 However, etiology varied widely by region, with HCV being the most common in the North (44.9%), HBV in the East (47.9%) and South (40.5%), alcohol in the North-East (31.9%), and NAFLD in the Central region (43.6%) and the West (39.6%). 23 CLD etiologies reported in other studies have varied widely, [24][25][26][27][28][29][30][31][32][33][34] likely due to variations by region, population, and over time. The latter has been shown in a study in a tertiary care referral hospital in Eastern India, where etiologies of CLD changed substantially from 2003 to 2011, with alcohol increasing from 22.5% to 42.0% (p = .01), cryptogenic (i.e.…”

“…During a median (range) hospital stay of 8 (4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14) days, 42.6% of patients died. 29 In a single-center study in Eastern India (2012-2014), the most common precipitants of acute decompensation among 123 patients with ACLF (mean age 45.8 ± 12.1 years; 88.6% male) were recent alcohol intake (42.3%) and bacterial infection (36.6%). 44 Three-month mortality was very high (71.3%), more so in alcoholics than nonalcoholics (81.1% vs. 55.9%; p = .01).…”

Acute on Chronic Liver Failure—What is in a ‘Definition’?

“…However, a recent study is significant as it seems to bring two definitions somewhat closer. On behalf of Indian Association for study of the liver (INASL) consortium for ACLF Research in the East or ICARE, Shalimar et al 31 have recently analyzed records of 1049 consecutive patients with ACLF satisfying APASL definition from 10 centers in India. They confirmed that mortality progressively increased with rising number of organ failures or OFs (12.3% with no OF and 83.3% with five OFs).…”