Impact of compensated cirrhosis on survival in patients with acute-on-chronic liver failure

Abstract

Background and aims Acute-on-chronic liver failure (ACLF) is considered a main prognostic event in patients with chronic liver disease (CLD). We analyzed the 28-day and 90-day mortality in ACLF patients with or without underlying cirrhosis enrolled in the ACLF Research Consortium (AARC) database. Methods A total of 1,621 patients were prospectively enrolled and 637 (39.3%) of these patients had cirrhosis. Baseline characteristics, complications and mortality were compared between patients with and without cirrhosis. Results Alcohol consumption was more common in cirrhosis than non-cirrhosis (66.4% vs. 44.2%, p < 0.0001), while non-alcoholic fatty liver disease/cryptogenic CLD (10.9% vs 5.8%, p < 0.0001) and chronic HBV reactivation (18.8% vs 11.8%, p < 0.0001) were more common in non-cirrhosis. Only 0.8% of patients underwent liver transplantation. Overall, 28-day and 90-day mortality rates were 39.3% and 49.9%, respectively. Patients with cirrhosis had a greater chance of survival compared to those without cirrhosis both at 28-day (HR = 0.48; 95% CI 0.36–0.63, p < 0.0001) and 90-day (HR = 0.56; 95% CI 0.43–0.72, p < 0.0001), respectively. In alcohol CLD, non-cirrhosis patients had a higher 28-day (49.9% vs. 23.6%, p < 0.001) and 90-day (58.4% vs. 35.2%, p < 0.001) mortality rate than cirrhosis patients. ACLF patients with cirrhosis had longer mean survival than non-cirrhosis patients (25.5 vs. 18.8 days at 28-day and 65.2 vs. 41.2 days at 90-day). Exaggerated systemic inflammation might be the reason why non-cirrhosis patients had a poorer prognosis than those with cirrhosis after ACLF had occurred. Conclusions The 28-day and 90-day mortality rates of ACLF patients without cirrhosis were significantly higher than those with cirrhosis in alcoholic CLD. The presence of cirrhosis and its stage should be evaluated at baseline to guide for management. Thai Clinical Trials Registry, TCTR20191226002.

Bacterial Infections Confer a Risk of Progression to Acute-on-Chronic Liver Failure in Patients with HBV-Related Compensated Cirrhosis During Severe Hepatitis Flares

“…Liver dysfunction and its related complications, such as portal-systemic shunting, bacterial translocation, and liver cirrhosis-associated immune dysfunction, have been implicated in the occurrence of BIs [ 21 , 22 ]. In patients with severe acute liver inflammation, an excessive hepatic inflammatory response has been found to exhaust the function of immune cells and result in immune paralysis [ 11 ]. These studies suggested that susceptibility to BIs is dependent on the severity of acute and chronic liver injury.…”

“…The World Gastroenterology Organization working party suggested that ACLF be classified into three types according to the underlying chronic liver disease as follows: type A from non-cirrhotic liver disease, type B from compensated cirrhosis, and type C from decompensated cirrhosis [ 10 ]. Recently, a few studies found that patients with ACLF developed from different underlying diseases had different prognoses [ 11 , 12 ]; therefore, it is clinically important to understand the clinical characteristics of patients with ACLF developed from different underlying liver diseases.…”

Challenges in Diagnosis and Therapeutic Approach of Acute on Chronic Liver Failure—A Review of Current Evidence

“…The impact of ACLF on cirrhotic and non-cirrhotic patients has varied among different studies. A study conducted by Thanapirom et al in 2021 in 1621 enrolled patients, which evaluated the impact of compensated cirrhosis on survival in patients with ACLF, showed that short-term mortality rates of ACLF in patients without cirrhosis were significantly increased compared to patients with alcoholic liver cirrhosis [148]. Shalimar et al found that alcohol liver injury was an independent risk factor related to increased mortality [149].…”

Investigation on the short‐term outcome and prognostic impact of predisposition, and precipitants in inpatients with chronic liver disease from Chinese AcuTe on CHronic LIver FailurE (CATCH‐LIFE) cohorts

“…Several previous studies 4, [7][8][9] investigating ACLF heterogeneity have provided clues. However, a survey systemically assessing the differential outcomes of inpatients with CLDs with a wide spectrum of severities and etiologies upon various inciting events is still lacking.…”