Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis

Gustot, Thierry; Fernandez, Javier; Garcia, Elisabet; Morando, Filippo; Caraceni, Paolo; Alessandria, Carlo; Laleman, Wim; Trebicka, Jonel; Elkrief, Laure; Hopf, Corinna; Solís-Munoz, Pablo; Saliba, Faouzi; Zeuzem, Stefan; Albillos, Augustin; Benten, Daniel; Montero-Alvarez, José Luis; Chivas, Maria Teresa; Concepción, Mar; Córdoba, Juan; McCormick, Aiden; ... (2015). Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis. Hepatology, 62(1), pp. 243-252. Wiley Interscience 10.1002/hep.27849

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Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation (AD) of cirrhosis, organ failure(s), and high 28-day mortality. We investigated whether assessments of patients at specific time points predicted their need for liver transplantation (LT) or the potential futility of their care. We assessed clinical courses of 388 patients who had ACLF at enrollment, from February through September 2011, or during early (28-day) follow-up of the prospective multicenter European Chronic Liver Failure (CLIF) ACLF in Cirrhosis study. We assessed ACLF grades at different time points to define disease resolution, improvement, worsening, or steady or fluctuating course. ACLF resolved or improved in 49.2%, had a steady or fluctuating course in 30.4%, and worsened in 20.4%. The 28-day transplant-free mortality was low-to-moderate (6%-18%) in patients with nonsevere early course (final no ACLF or ACLF-1) and high-to-very high (42%-92%) in those with severe early course (final ACLF-2 or -3) independently of initial grades. Independent predictors of course severity were CLIF Consortium ACLF score (CLIF-C ACLFs) and presence of liver failure (total bilirubin ≥12 mg/dL) at ACLF diagnosis. Eighty-one percent had their final ACLF grade at 1 week, resulting in accurate prediction of short- (28-day) and mid-term (90-day) mortality by ACLF grade at 3-7 days. Among patients that underwent early LT, 75% survived for at least 1 year. Among patients with ≥4 organ failures, or CLIF-C ACLFs >64 at days 3-7 days, and did not undergo LT, mortality was 100% by 28 days. CONCLUSIONS Assessment of ACLF patients at 3-7 days of the syndrome provides a tool to define the emergency of LT and a rational basis for intensive care discontinuation owing to futility.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie
04 Faculty of Medicine > Pre-clinic Human Medicine > BioMedical Research (DBMR) > DBMR Forschung Mu35 > Forschungsgruppe Hepatologie

04 Faculty of Medicine > Department of Gastro-intestinal, Liver and Lung Disorders (DMLL) > Clinic of Visceral Surgery and Medicine > Hepatology

UniBE Contributor:

De Gottardi, Andrea

Subjects:

600 Technology > 610 Medicine & health

ISSN:

0270-9139

Publisher:

Wiley Interscience

Language:

English

Submitter:

Lilian Karin Smith-Wirth

Date Deposited:

31 Mar 2016 15:11

Last Modified:

13 Sep 2017 06:54

Publisher DOI:

10.1002/hep.27849

PubMed ID:

25877702

BORIS DOI:

10.7892/boris.77706

URI:

https://boris.unibe.ch/id/eprint/77706

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