IDDF2022-ABS-0190 Prevalence and outcomes of acute-on-chronic liver failure in australia – a single-centre study

Chetwood, John; Sabih, Abdul-Hamid; Chan, Karen; Salimi, Shirin; Sheiban, Alex; Lin, Elton; Chin, Simone; Sastry, V.N.; Tsoutsman, Tatiana; Bowen, David; Majumdar, Avik; Strasser, Simone I.; McCaughan, Geoffrey W.

doi:10.1136/gutjnl-2022-iddf.118

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“… 4 This could have been due to the referral bias of our center being a specialized liver unit as shown by a similar Australian study (published in abstract form) showing a 34% prevalence of ACLF among patients admitted with AD. 17 Consistent with the available literature, our ACLF patients were younger, had higher MELD scores, were more likely to require admission to the intensive care unit (ICU) for inotropic support/mechanical ventilation/renal replacement therapy, and experienced longer lengths of stay.…”

Section: Discussionsupporting

confidence: 85%

Acute on chronic liver failure: A South Australian experience

Madigan,

Tashkent,

Trehan

et al. 2023

JGH Open

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Background and AimAcute on chronic liver failure (ACLF) is a clinical syndrome described in patients with acute decompensation (AD) of cirrhosis, characterized by organ failures and high mortality. Intensive management, including liver transplantation (LT), has been shown to improve survival. To address the limited Australian data on ACLF, we describe the prevalence, clinical profile, and outcome of ACLF in an Australian cohort of hospitalized patients.MethodsA retrospective review of hepatology admissions in a tertiary hospital from 1 January 2017 to 31 December 2019 identified AD and ACLF cohorts, as defined by the European Association for Study of the Liver definition. Patient characteristics, clinical course, survival at 28‐ and 90‐day survival, and feasibility of LT were analyzed.ResultsAmong the 192 admissions with AD, 74 admissions (39%) met ACLF criteria. A prior diagnosis of alcohol‐related cirrhosis was highly prevalent in both cohorts. Grade‐1 ACLF was the most frequent (60%), with renal failure being the commonest organ failure; 28‐day (23% vs 2%, P = <0.001) and 90‐day mortality (36% vs 16%, P = 0.002) were higher in ACLF than AD. Due to ongoing alcohol use disorder (AUD), only six patients underwent LT assessment during ACLF admission.ConclusionACLF was common in our cohort of cirrhosis with AD and was associated with high mortality. AUD despite prior cirrhosis diagnosis was a barrier to LT. Prioritization of ACLF patients for LT after addressing AUD and relaxation of the 6‐month abstinence rule may improve ACLF survival and should be addressed in prospective studies.

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Section: Discussionsupporting

confidence: 85%