Definitions, Etiologies, and Outcomes of Acute on Chronic Liver Failure: A Systematic Review and Meta-analysis

Aggarwal, Arnav; Biswas, Sagnik; Arora, Umang; Vaishnav, Manas; Shenoy, Abhishek; Swaroop, Shekhar; Agarwal, Ayush; Elhence, Anshuman; Kumar, Ramesh; Goel, Amit; Shalimar,

doi:10.1016/j.cgh.2024.04.018

Cited by 5 publications

(1 citation statement)

References 124 publications

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“…Acute on chronic liver failure (ACLF) is a serious condition that occurs in individuals with liver cirrhosis who experience an acute decompensation [ 6 ]. ACLF is typically characterized by a rapid progression of liver failure and is associated with high short-term mortality rates [ 7 ]. ACLF is categorized into three stages based on the severity of the condition: (i) stage 1 ACLF: this stage is considered when there is an acute deterioration of the liver function, but with no organ failures or complications; (ii) stage 2 ACLF is defined by the presence of single or multiple organ failures, such as kidney dysfunction, brain dysfunction (hepatic encephalopathy), or circulatory system issues.…”

Section: Introductionmentioning

confidence: 99%

The value of presepsin and procalcitonin as prognostic factors for mortality in patients with alcoholic liver cirrhosis and acute on chronic liver failure

Igna,

Muzica,

Zenovia

2024

Arch Clin Cases

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Background: Acute on chronic liver failure (ACLF) is typically characterized by a rapid progression of liver failure in patients with liver cirrhosis and it is triggered by a precipitant factor, usually a bacterial infection (BI). Considering the low accuracy of the inflammation biomarkers in liver cirrhosis, presepsin and procalcitonin have demonstrated a good diagnostic performance for BI. Understanding the key prognostic factors that influence patient outcomes can significantly impact clinical decision-making and improve patient care in ACLF which can lead to lower mortality rates. Aim: to evaluate the prognostic factors associated with 30-day mortality in patients with alcohol-related liver cirrhosis and ACLF. Methods: This retrospective study on 227 patients diagnosed with ACLF and alcohol-related liver cirrhosis analyzed the prognostic role of presepsin and procalcitonin serum levels. Results: The survival analysis according to the grade of ACLF showed that more than 80% of patients with ACLF grade 1 survived after 30 days, with a mean estimated time of death of 29 ±0.44 days (95 % CI: 28.17-29.92) compared to ACLF grade 2 (24.9±1.064 days; 95 % CI: 22.82-26.99) and ACLF grade 3 (21.05±1.17 days; 95 % CI: 18.75-23.34), with a mean overall survival on entire cohort of 25.69±0.52 days (95 % CI: 24.65-26.73). Presepsin (OR: 4.008, CI 95:3.130-6.456, p=0.001) and procalcitonin (OR: 3.666, CI 95:2.312-5.813, p=0.001) were the most significant factors associated with 30-day mortality. In ACLF grade 2, presepsin provides a better prediction of mortality at the cutoff value of 1050 pg/mL (Sensitivity 72%, Specificity 69%) than procalcitonin (AUC=0.727 95% CI 0.594-0.860, p 0.002) whereas in ACLF grade 3, a cutoff of 1450 pg/mL (Sensitivity 89%, Specificity 91%) presepsin had a more significant accuracy of mortality prediction (AUC=0.93 95% CI 0.81-0.99, p 0.001) than procalcitonin (AUC=0.731 95% CI 0.655-0.807, p 0.001). Conclusion: ACLF is associated with a high mortality rate and the risk of death increases with the grade of ACLF. Presepsin and procalcitonin serum levels are good prognostic factors for 30-day mortality and should be used in clinical practice to stratify the risk and provide and early and efficient treatment in patients with ACLF.

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Section: Introductionmentioning

confidence: 99%

The value of presepsin and procalcitonin as prognostic factors for mortality in patients with alcoholic liver cirrhosis and acute on chronic liver failure

Igna,

Muzica,

Zenovia

2024

Arch Clin Cases

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Reply to: “A consensus definition for ACLF – The need of the hour?”

Kulkarni,

Sarin

2025

Journal of Hepatology

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Editorial: Decoding ACLF—Sub‐Phenotyping to Advance Precision Medicine in Acute‐on‐Chronic Liver Failure. Authors' Reply

Garg,

Verma,

Duseja

2024

Aliment Pharmacol Ther

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We sincerely appreciate the insightful Editorial by Sangam et al. regarding our study [1,2]. We echo the call for harmonising definitions and prognostication in acute-on-chronic liver failure (ACLF) [3]. While the debate over definitions continues, the core concept of ACLF-a rapid deterioration due to an acute insult on chronic liver disease, with organ dysfunction and high shortterm mortality-remains consistent. The Asia Pacific (APASL) definition highlights liver-dominant injury without prior decompensation, whereas the European (EASL) definition includes patients with or without prior decompensation of cirrhosis and focuses on multi-organ failures. However, the core concept of acute worsening in the setting of chronic liver disease remains the common denominator (aka. Acute Decompensation-AD).

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Definitions, Etiologies, and Outcomes of Acute on Chronic Liver Failure: A Systematic Review and Meta-analysis

Cited by 5 publications

References 124 publications

The value of presepsin and procalcitonin as prognostic factors for mortality in patients with alcoholic liver cirrhosis and acute on chronic liver failure

The value of presepsin and procalcitonin as prognostic factors for mortality in patients with alcoholic liver cirrhosis and acute on chronic liver failure

Reply to: “A consensus definition for ACLF – The need of the hour?”

Editorial: Decoding ACLF—Sub‐Phenotyping to Advance Precision Medicine in Acute‐on‐Chronic Liver Failure. Authors' Reply

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