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Impact of Diabetes, Drug-Induced Liver Injury, and Sepsis on Outcomes in Metabolic Dysfunction Associated Fatty Liver Disease-Related Acute-on-Chronic Liver Failure.
Kumar, Ashish; Arora, Anil; Choudhury, Ashok; Arora, Vinod; Rela, Mohamed; Jothimani, Dinesh Kumar; Mahtab, Mamun A; Devarbhavi, Harshad; Eapen, Chundamanni E; Goel, Ashish; Yaghi, Cesar; Ning, Qin; Chen, Tao; Jia, Jidong; Zhongping, Duan; Hamid, Saeed S; Butt, Amna S; Jafri, Wasim; Shukla, Akash; Tan, Seok S; Kim, Dong J; Saraya, Anoop; Hu, Jinhua; Sood, Ajit; Goyal, Omesh; Midha, Vandana; Pati, Girish K; Singh, Ayaskant; Lee, Guan H; Treeprasertsuk, Sombat; Thanapirom, Kessarin; Mandot, Ameet; Maghade, Ravikiran; Lesmana, Rinaldi C; Ghazinyan, Hasmik; Mohan Prasad, Virukalpatti G; Dokmeci, Abdul K; Sollano, Jose D; Abbas, Zaigham; Shrestha, Ananta; Lau, George K; Payawal, Diana A; Shiha, Gamal E; Duseja, Ajay; Taneja, Sunil; Verma, Nipun; Rao, Padaki N; Kulkarni, Anand V; Karim, Fazal; Saraswat, Vivek A.
Afiliação
  • Kumar A; Sir Ganga Ram Hospital, Rajender Nagar, New Delhi, India.
  • Arora A; Sir Ganga Ram Hospital, Rajender Nagar, New Delhi, India.
  • Choudhury A; Institute of Liver and Biliary Sciences, New Delhi, India.
  • Arora V; Institute of Liver and Biliary Sciences, New Delhi, India.
  • Rela M; Dr. Rela Institute, Chennai, India.
  • Jothimani DK; Dr. Rela Institute, Chennai, India.
  • Mahtab MA; Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
  • Devarbhavi H; St. John's Medical College and Hospital, Bangalore, India.
  • Eapen CE; Christian Medical College, Vellore, India.
  • Goel A; Christian Medical College, Vellore, India.
  • Yaghi C; Saint Joseph University, Beirut, Lebanon.
  • Ning Q; Tongji Hospital, Wuhan/Capital Medical University, Beijing, China.
  • Chen T; Tongji Hospital, Wuhan, China.
  • Jia J; Tongji Hospital, Wuhan/Capital Medical University, Beijing, China.
  • Zhongping D; Youan Hospital Capital Medical University, Beijing, China.
  • Hamid SS; Aga Khan University Hospital, Karachi, Pakistan.
  • Butt AS; Aga Khan University Hospital, Karachi, Pakistan.
  • Jafri W; Aga Khan University Hospital, Karachi, Pakistan.
  • Shukla A; Seth GS Medical College and KEM Hospital, Mumbai, India.
  • Tan SS; Selayang Hospital University of Malaysia, Malaya, Malaysia.
  • Kim DJ; Chuncheon Sacred Heart Hospital, Chuncheon, Korea.
  • Saraya A; Institute of liver and Biliary Sciences, New Delhi, India.
  • Hu J; The Fifth Medical Centre of Chinese PLA General Hospital, Beijing, China.
  • Sood A; Dayanand Medical College, Ludhiana, India.
  • Goyal O; Dayanand Medical College, Ludhiana, India.
  • Midha V; Dayanand Medical College, Ludhiana, India.
  • Pati GK; IMS and Sum Hospital, Bhubaneswar, Odisha, India.
  • Singh A; SUM Ultimate Medicare and SUM Hospital, SOA University, Bhubaneswar, Odisha, India.
  • Lee GH; National University Hospital, Kent Ridge, Queenstown, Singapore.
  • Treeprasertsuk S; Chulalongkorn University, Bangkok, Thailand.
  • Thanapirom K; Chulalongkorn University, Bangkok, Thailand.
  • Mandot A; Global Hospital, Mumbai, India.
  • Maghade R; Global Hospital, Mumbai, India.
  • Lesmana RC; Digestive Disease and Oncology Center, Medistra Hospital, Jakarta, Indonesia.
  • Ghazinyan H; Nork Clinical Hospital of Infectious Disease, Yerevan, Armenia.
  • Mohan Prasad VG; Indira Gandhi Institute of Medical Sciences (IGIMS), Bely Road Patna, Bihar, India.
  • Dokmeci AK; Ankara University School of Medicine, Hacettepe, Ankara, Turkey.
  • Sollano JD; Cardinal Santos Medical Center, Metro Manila, Philippines.
  • Abbas Z; Dr. Ziauddin University Hospital, Clifton, Karachi, Pakistan.
  • Shrestha A; Alka Hospital, Lalitpur, Nepal.
  • Lau GK; Humanity and Health Medical Centre, Hong Kong, SAR, China.
  • Payawal DA; Fatima University Medical Center, Manila, Philippines.
  • Shiha GE; Egyptian Liver Research Institute and Hospital (ELRIAH), Egypt.
  • Duseja A; Post Graduate Institute of Medical Education and Research Chandigarh, India.
  • Taneja S; Post Graduate Institute of Medical Education and Research Chandigarh, India.
  • Verma N; Post Graduate Institute of Medical Education and Research Chandigarh, India.
  • Rao PN; Asian Institute of Gastroentrology, Somajiguda, Hyderabad, India.
  • Kulkarni AV; Asian Institute of Gastroentrology, Somajiguda, Hyderabad, India.
  • Karim F; Sir Salimullah Medical College, Mitford Hospital, Dhaka, Bangladesh.
  • Saraswat VA; Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India.
Am J Gastroenterol ; 2024 Jul 17.
Article em En | MEDLINE | ID: mdl-39016385
ABSTRACT

INTRODUCTION:

The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and its complication, MAFLD-related acute-on-chronic liver failure (MAFLD-ACLF), is rising. Yet, factors determining patient outcomes in MAFLD-ACLF remain understudied.

METHODS:

Patients with MAFLD-ACLF were recruited from the Asian Pacific Association for the Study of the Liver-ACLF Research Consortium (AARC registry). The diagnosis of MAFLD-ACLF was made when the treating unit had identified the etiology of chronic liver disease as MAFLD (or previous nomenclature such as non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, or non-alcoholic steatohepatitis-cirrhosis). Patients with coexisting other etiologies of chronic liver disease (such as alcohol, hepatitis B virus, hepatitis C virus, etc.) were excluded. Data were randomly split into derivation (n = 258) and validation (n = 111) cohorts at a 7030 ratio. The primary outcome was 90-day mortality. Only the baseline clinical, laboratory features and severity scores were considered.

RESULTS:

The derivation group had 258 patients; 60% were male, with a mean age of 53. Diabetes was noted in 27% and hypertension in 29%. The dominant precipitants included viral hepatitis (hepatitis A virus and hepatitis E virus, 32%), drug-induced injury (drug-induced liver injury, 29%), and sepsis (23%). Model for End-Stage Liver Disease-Sodium (MELD-Na) and AARC scores on admission averaged 32 ± 6 and 10.4 ± 1.9. At 90 days, 51% survived. Nonviral precipitant, diabetes, bilirubin, international normalized ratio, and encephalopathy were independent factors influencing mortality. Adding diabetes and precipitant to MELD-Na and AARC scores, the novel MAFLD-MELD-Na score (+12 for diabetes, +12 for nonviral precipitant), and MAFLD-AARC score (+5 for each) were formed. These outperformed the standard scores in both cohorts.

DISCUSSION:

Almost half of patients with MAFLD-ACLF die within 90 days. Diabetes and nonviral precipitants such as drug-induced liver injury and sepsis lead to adverse outcomes. The new MAFLD-MELD-Na and MAFLD-AARC scores provide reliable 90-day mortality predictions for patients with MAFLD-ACLF.

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Am J Gastroenterol / Am. j. gastroenterol. (Online) / The American journal of gastroenterology (Online) Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Índia

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Idioma: En Revista: Am J Gastroenterol / Am. j. gastroenterol. (Online) / The American journal of gastroenterology (Online) Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Índia