AIMS: We studied in-hospital predictors of mortality of acute on chronic liver failure (ACLF) in Indian patients. METHODS: Patients admitted to the intensive care unit of our institute fulfilling the definition of ACLF based on the Asia-Pacific Association for Study of Liver Disease (APASL) consensus were included. Complete history and medical evaluation to assess the etiology of underlying liver cirrhosis and to identify the acute precipitating insult of worsening liver function was done. Data was prospectively recorded and various scoring systems and individual clinical and laboratory parameters were assessed to identify predictors of 28 days mortality. RESULTS: 64 out of 240 patients screened for ACLF were analyszed in the study. Median age was 44 years and 53% were males. Alcohol was the primary cause of cirrhosis in 60.93%. Infections and active alcoholism was the main precipitating acute insult in 43% and 37% patients respectively. 28% patients had history of ingestion of hepato-toxic drugs as the acute insult. More than one acute insult was seen in 37.5% patients and type-II hepatic injury was the most common type. 28 days in hospital mortality was 43.75% and was highest in patients with sepsis (67.8%). Presence of hepato-renal syndrome and need for ventilation was associated with poor outcome. Though multiple variables were significant in predicting mortality on univariate analysis, yet on regression model only APACHE II and shock could significantly predict mortality with odds ratio of 3.18 and 9.14 respectively. Highest mortality was seen with cerebral and lung as organ failure and mortality increased as the number of organ failure worsened. CLIF-SOFA and APACHE-II scores having area under curve > 0.8 had higher ability to predict mortality. CONCLUSION: ACLF carries high short-term mortality and early intervention by liver transplantation should be considered in patients who shows high risk of mortality.
AIMS: We studied in-hospital predictors of mortality of acute on chronic liver failure (ACLF) in Indian patients. METHODS: Patients admitted to the intensive care unit of our institute fulfilling the definition of ACLF based on the Asia-Pacific Association for Study of Liver Disease (APASL) consensus were included. Complete history and medical evaluation to assess the etiology of underlying liver cirrhosis and to identify the acute precipitating insult of worsening liver function was done. Data was prospectively recorded and various scoring systems and individual clinical and laboratory parameters were assessed to identify predictors of 28 days mortality. RESULTS: 64 out of 240 patients screened for ACLF were analyszed in the study. Median age was 44 years and 53% were males. Alcohol was the primary cause of cirrhosis in 60.93%. Infections and active alcoholism was the main precipitating acute insult in 43% and 37% patients respectively. 28% patients had history of ingestion of hepato-toxic drugs as the acute insult. More than one acute insult was seen in 37.5% patients and type-II hepatic injury was the most common type. 28 days in hospital mortality was 43.75% and was highest in patients with sepsis (67.8%). Presence of hepato-renal syndrome and need for ventilation was associated with poor outcome. Though multiple variables were significant in predicting mortality on univariate analysis, yet on regression model only APACHE II and shock could significantly predict mortality with odds ratio of 3.18 and 9.14 respectively. Highest mortality was seen with cerebral and lung as organ failure and mortality increased as the number of organ failure worsened. CLIF-SOFA and APACHE-II scores having area under curve > 0.8 had higher ability to predict mortality. CONCLUSION: ACLF carries high short-term mortality and early intervention by liver transplantation should be considered in patients who shows high risk of mortality.
Entities:
Keywords:
ACLF, acute on chronic liver failure; APASL, Asia-Pacific Association for Study of Liver Disease; CLIF-SOFA; EASL, European Association for Study of Liver Disease; acute on chronic liver failure; intensive care unit; mortality; predictors
Authors: Rajiv Jalan; Pere Gines; Jody C Olson; Rajeshwar P Mookerjee; Richard Moreau; Guadalupe Garcia-Tsao; Vicente Arroyo; Patrick S Kamath Journal: J Hepatol Date: 2012-06-28 Impact factor: 25.083
Authors: Albert C Chan; Sheung Tat Fan; Chung Mau Lo; Chi Leung Liu; See Ching Chan; Kelvin K Ng; Boon Hun Yong; Alexander Chiu; Banny K Lam Journal: Hepatol Int Date: 2009-08-13 Impact factor: 6.047