Acute-On-Chronic Liver Failure-Outcome and Its Predictors in A Tertiary Care Hospital

Abstract

Objective: To determine the characteristics and outcome of acute-on-chronic liver failure patients being managed at PakEmirates Military Hospital Rawalpindi.
 Study Design: Cross-sectional study.
 Place and Duration of Study: Department of Gastroenterology at Pak-Emirates Military Hospital, Rawalpindi, from Sep 2018 to Jan 2021.
 Methodology: In this study, 1559 patients diagnosed with cirrhosis were studied. Patients with pre-existing chronic kidney disease, chronic obstructive pulmonary disease, cardiac failure, dementia, and stroke were excluded. All the relevant features of each case were recorded in the proforma.
 Results: Out of 1559 patients, 67 had Acute-on-chronic liver failure. The majority of patients who presented with acute-onchronic liver failure were in grade Ib (55%), followed by grade II (30%). Hepatitis C virus related liver cirrhosis was the commonest underlying liver disease (78.4%). Drugs were the commonest triggering factor (33%), followed by acute viral hepatitis (27%). However, a large number of patients had no identifiable cause (25.4%).
 Conclusion: Acute-chronic-liver failure is common in patients presenting with acute decompensation of liver cirrhosis. Patients undergoing liver transplantation in the correct window period, have good prognosis.

Acute-on-Chronic Liver Failure: Causes, Clinical Parameters, and Predictors of Mortality

“…Similarly, Saxena et al (2020) [ 13 ] and Behera et al (2021) [ 17 ] also documented that alcohol was the most common etiology of CLD, followed by HBV and HCV. Saad et al (2022) [ 15 ] reported a high prevalence of HCV at 78%, similar to the current study. The differences in etiological factors across studies underline the geographical and demographic variability in CLD causation.…”

“…Shin et al [ 14 ], in their study, recorded a median age of 54.8 years among participants, noting it did not markedly influence mortality rates (Hazard Ratio (HR) 1.00, 95% Confidence Interval (CI): 0.98-1.03, p=0.828) [ 14 ]. Saad et al (2022) [ 15 ] reported a higher mean age of 62 ± 7.2 years. Kulkarni et al (2018) [ 16 ] observed median ages of 42 years for those who survived and 47 years for those who did not (p=0.667) [ 16 , 17 ].…”

“…This aligns with gender distributions noted in the existing literature. Saad et al [ 15 ] identified a sample distribution of 67% male to 33% female, whereas Behera et al (2021) [ 17 ] found a male-to-female ratio 2.5:1. Reddy et al (2021) [ 12 ] reported a ratio of 3.7:1 among survivors and 4.2:1 among non-survivors (p=0.820), and El Sayed et al (2021) [ 8 ] likewise observed no significant gender-based differences in survival (p=0.721).…”

“…In the current study, the mortality rate was reported at 48.4%, aligning closely with the range of mortality rates noted in various studies on acute-on-chronic liver failure (ACLF). Reddy et al (2021) [ 12 ] reported a rate of 43.33%, Behera et al (2021) [ 17 ] 46.6%, and Saad et al (2022) [ 15 ] reported a mortality rate of 30% [ 13 , 16 , 18 ]. Similarly, Kulkarni et al (2018) [ 16 ] reported a death rate of 43.75%, while Garg et al (2012) [ 18 ] and Mikolasevic et al (2015) [ 19 ] both reported higher mortality rates of 50%.…”

“…Other studies have identified varying prevalences of ascites and HE, with Saad et al (2022) [ 15 ] reporting 59% and 18.5% for ascites and HE, respectively, while Behera et al (2021) [ 17 ] found ascites in 88% and HE in 60% of their patients. Shin et al (2020) [ 14 ] indicated ascites as a risk factor for mortality (HR 2.99, p=0.013), though HE was less common at 13% [ 15 ]. Saxena et al (2020) [ 13 ] observed ascites in 88% and jaundice in 100% of patients, with severe HE more prevalent in the death group (77% vs 22%, p=0.01) [ 14 ].…”