Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure

Hepatitis E and Acute-on-Chronic Liver Failure

“…The hallmark of the disease course of patients with ACLF is the appearance of organ failure, which progresses to multiorgan failure and death. In the study by Garg et al, 31 at admission, all patients had severe liver failure with either ascites (66%) or hepatic encephalopathy (8%), or both (26%). Severe dysfunction of two or more organs besides liver failure (which constituted multi-organ failure) was present in 29% patients at admission.…”

“…34 In a large prospective study on ACLF, Garg et al have described the clinical, biochemical and etiological profiles of 91 ACLF patients. 31 The median ages of these patients was 36 years and most were males. Acute onset ascites with jaundice with or without hepatic encephalopathy was the presenting symptom in 92% of cases, and rest 8% presented with only hepatic encephalopathy with jaundice but no ascites (acute liver failure like presentation).…”

“…17 Subsequently, many publications have reported HEV as one of the leading causes for decompensation of cirrhosis from Asia and Africa, where HEV is endemic (Table 1). 14,15,[17][18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33] Most of these studies have used the APASL definition of ACLF and in median21% of cases (range 4-72%) of ACLF, HEV was the precipitating cause for liver decompensation. This contrasts with the Western countries where HEV is rarely the precipitating cause of acute decompensation in ACLF.…”

“…In 75% patients the acute and chronic insult had same etiology (alcohol or hepatitis B), whilst in 25% patients the etiology of chronic and acute insults were different from each other and in these patients, 61% had hepatitis E viral infection as acute insult. 31 In the study by Radha Krishna et al 26 which had maximum patients of HEV-related ACLF (HEV-ACLF) from India (80 out of 121 [66%] patients of ACLF), the 26 Zhang et al 27 from China, compared the effects of HEV superinfection with HAV superinfection in their cohort of patients with chronic hepatitis B. In contrast to other smaller studies which could not discern any difference in presentation among ACLF of different etiologies, Zhang et al were able to show that HEV-ACLF was indeed a more severe illness than HAV-ACLF.…”

“…The number of organ systems failed significantly correlates with hospital mortality; with rates ranging from 26% in patients with only one organ failure to >90% in patients with four or more organ system failures. 31 Besides number of organs failed there are various other variables which help in determining prognosis. A recent systematic review aimed to identify prognostic indicators for patients with ACLF.…”