Clinical Features of Hepatitis C Virus-related Acute-on-chronic Liver Failure in a Korean Population

Abstract

Background/Aims: Acute-on-chronic liver failure (ACLF) is a widely recognized concept in which acute decompensation (AD) in patients with cirrhosis results in organ failure and high short-term mortality. On the other hand, few studies reflecting the various etiologies of cirrhosis are available. This study examined the clinical features of patients with hepatitis C virus (HCV)-related ACLF. Methods: Between January 2005 and December 2018, 109 HCV-related cirrhosis patients hospitalized for AD (ascites, hepatic encephalopathy, gastrointestinal hemorrhage, and bacterial infection) were enrolled for ACLF defined by the European Association for the Study of the Liver (EASL). Results: ACLF developed in 35 patients (32.1%) on admission. Eight, eight, and 19 patients had ACLF grades 1, 2, and 3, respectively. The 28-day and 90-day mortality rates were very low (2.7% and 5.4%, respectively) in patients without ACLF and very high (60.0% and 74.3%, respectively) in those with ACLF. In patients with HCV-related ACLF, compared to previous studies on hepatitis B virus-related ACLF and alcohol-related ACLF, the prevalence of liver failure was very low (17.1%), whereas that of kidney failure was very high (71.4%). Compared with all other prognostic scores, the Chronic liver failure Consortium Organ Failure score predicted the 90-day mortality most accurately, with an area under the receiver operator characteristic of 0.921. Conclusions: HCV-related ACLF has unique clinical characteristics distinct from hepatitis B virus-related and alcohol-related ACLF. ACLF defined by EASL can be useful for predicting the short-term mortality in HCV-related cirrhosis.

Chronic Hepatitis C: Acute Exacerbation and Alanine Aminotransferase Flare

“…DAAs may be effective for the prevention of development into ALF among patients with acute HCV infection [ 124 ]. In patients with HCV-related ACLF, compared to previous studies on hepatitis B virus-related ACLF and alcohol-related ACLF, the prevalence of liver failure was very low (17.1%), whereas that of kidney failure was very high (71.4%) [ 125 ]. DAAs may not be effective for all patients with HCV infection and ACLF [ 126 ].…”

“…DAAs may not be effective for all patients with HCV infection and ACLF [ 126 ]. In the DAA era, however, as HCV infection may occasionally be associated with ACLF, which could lead to poor survival [ 125 , 126 , 127 , 128 , 129 ], we also focused on HCV acute exacerbation and ALT flare in this article. Although there are several excellent reviews about acute exacerbation and alanine aminotransferase flare in HCV carrier patients [ 77 , 86 ], we added the recent literature and reports in this review.…”

To TIPS or Not to TIPS in High Risk of Variceal Rebleeding and Acute-on-Chronic Liver Failure

“…The investigators usually observed a similar or even significantly higher proportion of GIB in AD without ACLF than with ACLF. 8,11,17,19,20,23,25,28,29 Reasons for this may be multi-factorial. On one hand, bleeding may occur in the early stages of cirrhosis decompensation, while organ functions are preserved.…”

“…In a previous study, ACLF was diagnosed at admission in almost 20% of patients with portal hypertension bleeding. 16 In studies of patients with decompensated cirrhosis of predominantly alcoholic or hepatitis C virus (HCV) etiologies, the proportion ranged from 8.6 to 49.4%, [17][18][19][20][21][22][23][24] and from 7.3 to 35.7% in HBV-related cirrhosis (►Table 1). 17, [25][26][27][28] In all of To TIPS or Not to TIPS in High Risk of Variceal Rebleeding and ACLF Gu et al 193 these studies, due to their retrospective nature, GIB occurred concomitant with ACLF and not as a definite precipitant.…”