Acute on chronic liver failure: Diagnosis and evolution profile

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Published Jan 2, 2025
https://doi.org/10.62438/tunismed.v103i1.5035
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Vol. 103 No. 1 (2025): Tunis Med Jan 2025

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Asma Mensi
Department of Gastroenterology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis-Manar, Tunis, Tunisia
Rayhan Zmerli
Department of Gastroenterology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis-Manar, Tunis, Tunisia
Emna Bel Hadj Mabrouk
Department of Gastroenterology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis-Manar, Tunis, Tunisia
Yosra Zaimi
Department of Gastroenterology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis-Manar, Tunis, Tunisia
Yosra Said
Department of Gastroenterology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis-Manar, Tunis, Tunisia
Radhouane Debbeche
Department of Gastroenterology, Charles Nicolle Hospital, Faculty of Medicine of Tunis, University of Tunis-Manar, Tunis, Tunisia

Abstract

Introduction: Acute decompensation represents a remarkable event in cirrhotic patients, particularly if it is complicated by Acute-on-Chronic Liver Failure (ACLF). Epidemiological data of ACLF are limited.


Aim: To determine the prevalence and predictive factors of ACLF in patients hospitalized for decompensated cirrhosis.


Methods: We conducted a retrospective study. We included patients with decompensated cirrhosis. ACLF was defined according to the CLIF-C OF score. Prevalence and predictive factors of ACLF were determined.


Results: We included 100 patients. The prevalence of ACLF was 37%. Renal failure was the most frequent organ failure. In univariate analysis, predictive factors for the occurrence of ACLF were female gender, hepatic encephalopathy, upper digestive haemorrhage, the presence of an infection, CRP level, bilirubin level and creatinine level. Prognostic scores (Child-Pugh, MELD, and CLIF-C OF) were also predictive of ACLF. In multivariate analysis, only creatinine level was an independent predictive factor of ACLF. The most frequent precipitating factor of ACLF was infection. The overall mortality rate for patients with ACLF was 65%.


Conclusion: Our study showed that the prevalence of ACLF was 37 %. The main predictive factor of ACLF was creatinine level. The mortality rate was high at 65 %.  

Keywords:

Cirrhosis, Acute on chronic liver failure, Prevalence

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References

  1. Williams EJ, Iredale JP. Liver cirrhosis. Postgrad Med J. 1998 Apr;74(870):193-202.
  2. Ginès P, Krag A, Abraldes JG, Solà E, Fabrellas N, Kamath PS. Liver cirrhosis. Lancet. 2021 Oct;398(10308):1359-76.
  3. Arroyo V, Moreau R, Kamath PS, Jalan R, Ginès P, Nevens F, et al. Acute-on-chronic liver failure in cirrhosis. Nat Rev Dis Primers. 2016 Jun;2:16041.
  4. De Franchis R, Bosch J, Garcia Tsao G, Reiberger T, Ripoll C, Abraldes JG, et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatol. 2022 Apr;76(4):959-74.
  5. Moreau R, Jalan R, Gines P, Pavesi M, Angeli P, Cordoba J, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 2013 Jun;144(7):1426-37.
  6. Moreau R, Gao B, Papp M, Bañares R, Kamath PS. Acute-on-chronic liver failure: a distinct clinical syndrome. J Hepatol. 2021 Jul;75Suppl 1:27-35.
  7. Zaccherini G, Weiss E, Moreau R. Acute-on-chronic liver failure: definitions, pathophysiology and principles of treatment. JHEP Rep. 2020 Sep;3(1):100176.
  8. Mezzano G, Juanola A, Cardenas A, Mezey E, Hamilton JP, Pose E, et al. Global burden of disease: acute-on-chronic liver failure, a systematic review and meta-analysis. Gut. 2022 Jan;71(1):148-55.
  9. Ben Abdelwahed M. Incidence et mortalité de l'insuffisance hépatique aiguë sur chronique chez les patients avec cirrhose du foie décompensée [thèse : médecine]. Monastir : Université de Monastir; 2020.
  10. Trad N. Décompensation aiguë sur chronique: Rôle de l'inflammation systémique [mémoire : médecine]. Tunis : Université de Tunis El Manar; 2021.
  11. Hernaez R, Kramer JR, Liu Y, Tansel A, Natarajan Y, Hussain KB, et al. Prevalence and short-term mortality of acute-on-chronic liver failure: a national cohort study from the USA. J Hepatol. 2019 Apr;70(4):639-47.
  12. Moreau N, Wittebole X, Fleury Y, Forget P, Laterre PF, Castanares Zapatero D. Neutrophil-to-Lymphocyte ratio predicts death in acute-on-chronic liver failure patients admitted to the intensive care unit: a retrospective cohort study. Shock. 2018 Apr;49(4):385-92.
  13. Shi Y, Yang Y, Hu Y, Wu W, Yang Q, Zheng M, et al. Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults. Hepatology. 2015 Jul;62(1):232-42.
  14. Medzhitov R, Schneider DS, Soares MP. Disease tolerance as a defense strategy. Science. 2012 Feb;335(6071):936-41.
  15. Khedher S, Fouthaili N, Maoui A, Lahiani S, Salem M, Bouzid K. The diagnostic and prognostic values of C-reactive protein and procalcitonin during bacterial infections in decompensated cirrhosis. Gastroenterol Res Pract. 2018 Dec;2018:5915947.
  16. Piano S, Tonon M, Vettore E, Stanco M, Pilutti C, Romano A, et al. Incidence, predictors and outcomes of acute-on-chronic liver failure in outpatients with cirrhosis. J Hepatol. 2017 Dec;67(6):1177-84.
  17. Arroyo V, Moreau R, Jalan R, Ginès P. Acute-on-chronic liver failure: a new syndrome that will re-classify cirrhosis. J Hepatol. 2015 Apr;62Suppl 1:131-43.
  18. Fernández J, Prado V, Trebicka J, Amoros A, Gustot T, Wiest R, et al. Multidrug-resistant bacterial infections in patients with decompensated cirrhosis and with acute-on-chronic liver failure in Europe. J Hepatol. 2019 Mar;70(3):398-411.
  19. Cao ZJ, Liu YH, Zhu CW, Yin S, Wang WJ, Tang WL, et al. Bacterial infection triggers and complicates acute-on-chronic liver failure in patients with hepatitis B virus-decompensated cirrhosis: a retrospective cohort study. World J Gastroenterol. 2020 Feb;26(6):645-56.
  20. Biyik M, Ucar R, Solak Y, Gungor G, Polat I, Gaipov A, et al. Blood neutrophil-to-lymphocyte ratio independently predicts survival in patients with liver cirrhosis. Eur J GastroenterolHepatol. 2013 Apr;25(4):435-41.
  21. Allaire M, Cadranel JF, Nguyen TN, Garioud A, Zougmore H, Heng R, et al. Management of infections in patients with cirrhosis in the context of increasing therapeutic resistance: a systematic review. Clin Res HepatolGastroenterol. 2020 Jun;44(3):264-74.
  22. Ferrer R, Martin Loeches I, Phillips G, Osborn TM, Townsend S, Dellinger RP, et al. Empiric antibiotic treatment reduces mortality in severe sepsis and septic shock from the first hour: results from a guideline-based performance improvement program. Crit Care Med. 2014 Aug;42(8):1749-55.
  23. Angeli P, Bernardi M, Villanueva C, Francoz C, Mookerjee RP, Trebicka J, et al. EASL clinical practice guidelines for the management of patients with decompensated cirrhosis. J Hepatol. 2018 Aug;69(2):406-60.
  24. Thuluvath PJ, Thuluvath AJ, Hanish S, Savva Y. Liver transplantation in patients with multiple organ failures: Feasibility and outcomes. J Hepatol. 2018 Nov;69(5):1047-56.
  25. Artru F, Louvet A, Ruiz I, Levesque E, Labreuche J, UrsicBedoya J, et al. Liver transplantation in the most severely ill cirrhotic patients: a multicenter study in acute-on-chronic liver failure grade 3. J Hepatol. 2017 Oct;67(4):708-15.