Impact of compensated cirrhosis on survival in patients with acute-on-chronic liver failure.
Acute-on-chronic liver failure
Chronic liver disease
Cirrhosis
Liver injury
Mortality
Prognosis
Journal
Hepatology international
ISSN: 1936-0541
Titre abrégé: Hepatol Int
Pays: United States
ID NLM: 101304009
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
24
08
2021
accepted:
24
10
2021
pubmed:
26
11
2021
medline:
17
2
2022
entrez:
25
11
2021
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND AND AIMS
OBJECTIVE
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
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
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
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.
Identifiants
pubmed: 34822057
doi: 10.1007/s12072-021-10266-8
pii: 10.1007/s12072-021-10266-8
pmc: PMC8844167
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
171-182Subventions
Organisme : Ratchadaphiseksomphot Endowment Fund of hepatic fibrosis and cirrhosis research unit
ID : GRU 6105530009-1.
Investigateurs
Shiv Kumar Sarin
(SK)
Ashok Choudhury
(A)
Manoj K Sharma
(MK)
Rakhi Maiwall
(R)
Mamun Al Mahtab
(MA)
Salimur Rahman
(S)
Sanjiv Saigal
(S)
Neeraj Saraf
(N)
A S Soin
(AS)
Harshad Devarbhavi
(H)
Dong Joon Kim
(DJ)
R K Dhiman
(RK)
Ajay Duseja
(A)
Sunil Taneja
(S)
C E Eapen
(CE)
Ashish Goel
(A)
Q Ning
(Q)
Tao Chen
(T)
Ke Ma
(K)
Z Duan
(Z)
Chen Yu
(C)
Sombat Treeprasertsuk
(S)
S S Hamid
(SS)
Amna S Butt
(AS)
Wasim Jafri
(W)
Akash Shukla
(A)
Vivek Saraswat
(V)
Soek Siam Tan
(SS)
Ajit Sood
(A)
Vandana Midha
(V)
Omesh Goyal
(O)
Hasmik Ghazinyan
(H)
Anil Arora
(A)
Jinhua Hu
(J)
Manoj Sahu
(M)
P N Rao
(PN)
Guan H Lee
(GH)
Seng G Lim
(SG)
Laurentius A Lesmana
(LA)
Cosmas Rinaldi Lesmana
(CR)
Samir Shah
(S)
V G Mohan Prasad
(VG)
Diana A Payawal
(DA)
Zaigham Abbas
(Z)
A Kadir Dokmeci
(A)
Jose D Sollano
(JD)
Gian Carpio
(G)
Ananta Shresta
(A)
G K Lau
(GK)
Md Fazal Karim
(M)
Gamal Shiha
(G)
Rino Gani
(R)
Kemal Fariz Fariz Kalista
(KFF)
Man-Fung Yuen
(MF)
Seema Alam
(S)
Rajeev Khanna
(R)
Vikrant Sood
(V)
Bikrant Bihari Lal
(BB)
Viniyendra Pamecha
(V)
Ankur Jindal
(A)
V Rajan
(V)
Vinod Arora
(V)
Osamu Yokosuka
(O)
Madunil A Niriella
(MA)
Hai Li
(H)
Xiaolong Qi
(X)
Atsushi Tanaka
(A)
Satoshi Mochida
(S)
Dominic Ray Chaudhuri
(DR)
Ed Gane
(E)
Khin Maung Win
(KM)
Wei Ting Chen
(WT)
Mohd Rela
(M)
Dharmesh Kapoor
(D)
Amit Rastogi
(A)
Pratibha Kale
(P)
Archana Rastogi
(A)
Chhagan Bihari Sharma
(CB)
Meenu Bajpai
(M)
Virender Singh
(V)
Madhumita Premkumar
(M)
Sudhir Sudhir
(S)
A Olithselvan
(A)
Cyriac Abby Philips
(CA)
Anshu Srivastava
(A)
Surender K Yachha
(SK)
Zeeshan Ahmad Wani
(ZA)
B R Thapa
(BR)
Anoop Saraya
(A)
None Shalimar
Ashish Kumar
(A)
Manav Wadhawan
(M)
Subash Gupta
(S)
Kaushal Madan
(K)
Puja Sakhuja
(P)
Vivek Vij
(V)
Barjesh C Sharma
(BC)
Hitendra Garg
(H)
Vishal Garg
(V)
Chetan Kalal
(C)
Lovkesh Anand
(L)
Tanmay Vyas
(T)
Rajan P Mathur
(RP)
Guresh Kumar
(G)
Priyanka Jain
(P)
Samba Siva Rao Pasupuleti
(SSR)
Yogesh K Chawla
(YK)
Abhijit Chowdhury
(A)
Shahinul Alam
(S)
Do Seon Song
(DS)
Jin Mo Yang
(JM)
Informations de copyright
© 2021. The Author(s).
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