Acute on chronic liver failure- etiology, clinical profile, prognostic scores: experience from tertiary care centre of eastern India

Abstract

Background: Acute on chronic liver failure (ACLF) is a recently recognised entity in chronic liver disease patients. Data regarding ACLF in terms of clinical presentation, etiology of underlying cirrhosis, precipitating factors, prognostic factors are lacking from eastern India. The present study was undertaken to evaluate the above factors along with the assessment of short-term mortality (4 weeks) in patients of ACLF.Methods: In this prospective observational study, 120 patients diagnosed as ACLF were included. A comparison of complications, biochemical profiles and prognostic scores was made between the survivor and non-survivor groups.Results: Of the 120 ACLF patients included, the mean age was 44.9±8.6 years and the male to female ratio was 2.5:1. Common clinical presentations were jaundice (100%), ascites (88.3%), hepatic encephalopathy (60%). The most common etiology for underlying CLD was alcohol (51.7%) followed by chronic hepatitis B (20%) and chronic hepatitis C (15%) infection. Alcohol hepatitis (40%) followed by hepatotropic viral infections (20%) and drug-induced liver injury (15%) were common identifiable precipitating agents. After a follow-up period of 4 weeks, 56 (46.6%) out of 120 patients died. The presence of sepsis, hyponatremia, renal failure, and coagulopathy was significantly associated with high mortality. Mortality was higher among patients having high Chronic liver failure consortium- acute on chronic liver failure (CLIF-ACLF) grade and closely related to the number of organ failures.Conclusions: ACLF is a rapidly progressive syndrome in chronic liver disease patients, having high short-term mortality.

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

“…In contrast, Mikolasevic et al in 2015 [ 19 ] identified alcohol as the leading cause of CLD in 77.7% of their study population, while Garg et al in 2012 [ 18 ] and Tasneem et al in 2017 [ 7 ] reported HBV as the most prevalent etiology, with incidences of 37% and 25% respectively. 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.…”

“…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 ]. Tasneem et al (2017) [ 7 ] reported that individuals over 40 years exhibited a higher risk of mortality (p=0.036, Odds Ratio [OR] = 0.325).…”

“…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%.…”

“…This contrasts with Tasneem et al (2017) [ 7 ], who highlighted acute viral hepatitis, primarily hepatitis E virus (HEV), as the leading cause at 33.3%, and Saad et al (2022) [ 15 ], who reported drugs as the primary etiology at 33%. El Sayed et al (2021) [ 8 ] and Behera et al (2021) [ 17 ] identified SBP and alcoholic hepatitis as major factors, with the latter noting significant outcome differences in relation to alcoholic hepatitis (p=0.017) and upper gastrointestinal (GI) bleeding (p=0.002). Saxena et al (2020) [ 13 ] reported alcohol as the leading cause at 50%.…”