Prevalence and Short-term Mortality of Acute-on-Chronic Liver Failure: a national cohort study from the USA.

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Prevalence and Short-term Mortality of Acute-on-Chronic Liver Failure: a national cohort study from the USA.

J Hepatol. 2018 Dec 24;:

Authors: Hernaez R, Kramer JR, Liu Y, Tansel A, Natarajan Y, Hussain KB, Gines P, Sola E, Moreau R, Gerbes A, El-Serag HB, Kanwal F

BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is characterized by the presence of organ failure in patients with decompensated cirrhosis and is associated with high short-term mortality. However, there are limited data on the prevalence and short-term outcomes of ACLF in cirrhosis patients seen in the U.S.
METHODS: Using the U.S. Department of Veterans Affairs (VA) Corporate Data Warehouse (CDW), we identified patients with ACLF during hospitalization for decompensated cirrhosis at any of the 127 VA hospitals between 01/01/2004 and 12/31/2014. We examined the prevalence of ACLF and variables associated with 28 and 90-day mortality in ACLF, and trends in prevalence and survival over time.
RESULTS: Of 72,316 patients hospitalized for decompensated cirrhosis, 19,082 (26.4%) patients met the criteria of ACLF on admission. Of these, 12.8% had 1, 10.1% had 2, and 3.5% had 3 or more organ failures. Overall, 25.5% and 40.0% of ACLF patients died within 28 days and 90 days of admission, respectively. Older age, white race, liver cancer, higher MELD-Na score and non- liver transplant center were associated with increased risk of death in ACLF. Over the study period, the prevalence of ACLF decreased, and all grades but ACLF-3 had improvement in survival.
CONCLUSIONS: In a U.S. cohort of hospitalized patients with decompensated cirrhosis, ACLF was common and associated with high short-term mortality. Over a decade, ACLF prevalence decreased but survival improvement of ACLF grade 3 was not seen. Early recognition and aggressive management including timely referral to transplant centers may lead to improved outcomes in ACLF.
LAY SUMMARY: Acute-on-chronic liver failure (ACLF) is a condition marked by multiple organ failures in patients with cirrhosis and associated with a high risk of death. In this study of U.S. patients hospitalized with cirrhosis, one in four patients developed ACLF. In total, 25% of patients with ACLF died within one month and 40% died within 3 months. Early recognition of ACLF is important to intervene aggressively in these patients to save their lives.

PMID: 30590100 [PubMed - as supplied by publisher]

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