Acute‐on‐chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults

Shi, Yu; Yang, Ying; Hu, Yaoren; Wu, Wei; Yang, Qiao; Zheng, Min; Zhang, Shun; Xu, Zhaojun; Wu, Yihua; Yan, Huadong; Chen, Zhi

doi:10.1002/hep.27795

Cited by 278 publications

(287 citation statements)

References 33 publications

Supporting

Mentioning

259

Contrasting

Unclassified

Order By: Relevance

“…In contrast, a Chinese study showed comparable 28-day mortality (50.7% vs. 48.3%, P = 0.22) but increased 90-day mortality in extrahepatic ACLF than hepatic ACLF group (68.3% vs. 58.9%, P = 0.035). 17 This difference could be explained by the fact that the majority of hepatic ACLF in the Chinese study was due to HBV flare on underlying HBV cirrhosis, which is an imminently treatable condition by use of potent antivirals, unlike severe alcoholic hepatitis, which was the most common cause of hepatic ACLF in our study. Hence, 90-day mortality in hepatic ACLF group was high in our study compared to the previous study, and we did not find any difference in mortality between hepatic and extrahepatic ACLF.…”

Section: Discussionmentioning

confidence: 55%

“…This is in contrast to studies from East Asia where hepatitis B is the predominant cause of chronic liver disease as well as acute insult in patients with ACLF. 17 Patients with hepatic ACLF had higher bilirubin values and higher proportion of liver failure when compared to extrahepatic ACLF. In addition, hepatic ACLF group had higher MELD and CLIF-SOFA score at admission.…”

Section: Discussionmentioning

confidence: 90%

See 1 more Smart Citation

Impact of Hepatic and Extrahepatic Insults on the Outcome of Acute-on-Chronic Liver Failure

Gupta

Dhiman

Rathi

et al. 2017

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

Background: To study the differences in outcome and predictors of mortality in acute-on-chronic liver failure (ACLF) precipitated by hepatic or extrahepatic insults. Methods: Consecutive patients of cirrhosis with acute decompensation were prospectively included and followed up for 90 days from admission. ACLF was defined based on chronic liver failure (CLIF) acute-on-chronic liver failure in cirrhosis (CANONIC study) criteria. Acute worsening due to acute viral hepatitis A and E, hepatitis B flare, alcoholic hepatitis, autoimmune hepatitis flare, or drug-induced liver injury were categorized as hepatic ACLF and that due to bacterial infection, upper gastrointestinal bleed or surgery as extrahepatic ACLF. Patients with both hepatic and extrahepatic insults were included in combined insult group. Results: Of 179 patients of acute decompensation, 122 had ACLF (hepatic insults 47 and extrahepatic insults 51). Alcohol (64.8%) was the most common etiology of cirrhosis while infection (36%) was the most common acute insult followed by alcoholic hepatitis (24.6%). Higher proportion of extrahepatic ACLF patients had history of prior decompensation than hepatic ACLF patients (62.7% vs. 27.7%, P < 0.001). There was no difference in mortality among hepatic and extrahepatic ACLF groups at 28 and 90 days (53.2% vs. 56.9%, P = 0.715 and 85% vs. 74.5%, P = 0.193, respectively). Area under receiver-operating curve (AUROC) for 28-day mortality in extrahepatic ACLF group was 0.788, 0.724, 0.718, 0.634, and 0.726 and in hepatic-ACLF group was 0.786, 0.625, 0.802, 0.761, and 0.648 for chronic liver failure-sequential organ failure assessment (CLIF-SOFA), model for end stage liver disease (MELD), integrated MELD score (iMELD), acute physiology and chronic health evaluation score (APACHE-II), and Child-Turcotte-Pugh score scores, respectively. Conclusion: There is no difference in mortality among hepatic and extrahepatic ACLF groups at 28 and 90 days. iMELD and CLIF-SOFA have highest AUROC to predict 28-day mortality in hepatic and extrahepatic ACLF groups, respectively. ( J CLIN EXP HEPATOL 2017;7:9-15)

show abstract

Section: Discussionmentioning

confidence: 55%

Section: Discussionmentioning

confidence: 90%

Impact of Hepatic and Extrahepatic Insults on the Outcome of Acute-on-Chronic Liver Failure

Gupta

Dhiman

Rathi

et al. 2017

Journal of Clinical and Experimental Hepatology

View full text Add to dashboard Cite

show abstract

“…Indeed, Xun et al (8) reported that the integrated MELD (iMELD) and MELD with incorporation of sodium (MELD-Na) models predicted 3-month mortality rates more accurately than traditional MELD. Furthermore, Shi et al (9) demonstrated that iMELD predicted hepatic-ACLF more accurately when compared with various other scoring systems (9). However, the prognostic assessment of ACLF in patients with multiple organ failure remains to be examined.…”

Section: Introductionmentioning

confidence: 99%

Prognostic performance of clinical indices and model scorings for acute-on-chronic liver failure: A study of 164 patients

Zhang

Guo

Zhao

et al. 2016

Experimental and Therapeutic Medicine

View full text Add to dashboard Cite

Abstract.The present study aimed to analyze the prognostic factors of acute-on-chronic liver failure (ACLF), with the perspective of an improved selection of optimal therapeutic schemes. A retrospective analysis was used to study 164 patients with ACLF hospitalized between 2010 and 2014 in a single center. Patients were divided into favorable and unfavorable groups, according to the treatment outcomes. General characteristics and clinical manifestations were analyzed to determine whether they would affect the prognosis of the patients with ACLF, with a particular focus on the scoring systems Child-Pugh, model for end-stage liver disease (MELD), MELD with incorporation of sodium (MELD-Na), MELD and serum sodium ratio (MESO) and integrated MELD (iMELD). Hepatitis B virus infection was the predominant cause of ACLF, accounting for 88 cases (53.7%). Age, prothrombin time, thrombin time, international normalized ratio (INR), prothrombin activity, serum sodium, albumin, total bilirubin, serum creatinine, platelets, fasting blood sugar, infections, hepatic encephalopathy, hepatorenal syndrome (HRS), and electrolyte disorder were revealed to be associated with prognosis. Age, serum sodium, INR, HRS, and infection were independent prognostic risk factors, as determined by multivariate analysis. Child-Pugh, MELD, MELD-Na, MESO and iMELD scoring systems all demonstrated adequate predictive values, with MELD-Na as the most effective scoring system. In conclusion, age, hyponatremia, INR, HRS and bacterial or fungal infections were reported to be independent prognostic risk factors for ACLF. Among the various liver function scoring systems, MELD-Na was the most accurate in predicting the prognosis of ACLF.

show abstract

“…Nonetheless, extrahepatic insults can be linked to a different outcome [7] . A potential precipitating event of the syndrome may not be identifiable [3] .…”

Section: Introductionmentioning

confidence: 99%

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

Verdelho

Perdigoto

Machado

et al. 2017

GE Port J Gastroenterol

View full text Add to dashboard Cite

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.

show abstract

Acute‐on‐chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults

Cited by 278 publications

References 33 publications

Impact of Hepatic and Extrahepatic Insults on the Outcome of Acute-on-Chronic Liver Failure

Impact of Hepatic and Extrahepatic Insults on the Outcome of Acute-on-Chronic Liver Failure

Prognostic performance of clinical indices and model scorings for acute-on-chronic liver failure: A study of 164 patients

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

Contact Info

Product

Resources

About