Prevalence and outcomes of acute-on-chronic liver failure among cirrhotic patients admitted for an acute decompensation.

BACKGROUND: Acute-on-chronic liver failure (ACLF) is a common syndrome that occurs in patients with advanced chronic liver disease. It consists of the rapid failure of various organs and is associated with high short-term mortality. We aim to describe the main features and outcomes of inpatients who developed ACLF and to identify the factors associated with in-hospital and 28-day mortality. PATIENTS AND METHODS: All patients meeting ACLF criteria with advanced chronic liver disease admitted for decompensation from January 2014 to December 2016 were identified. Clinical and biological data were collected at the time of ACLF diagnosis and at 3-7 days thereafter, as well as in-hospital and 28-day mortality. RESULTS: Eighty nine out of 354 admission episodes (28%) developed ACLF, which was present at the time of admission in 72% of cases. A precipitating factor was identified in 83% of cases, the most frequent being infection (53%) and gastrointestinal bleeding (19%). In the multivariate regression analysis, the ACLF grade at 3-7 days after diagnosis was predictive of in-hospital mortality and 28-day mortality, and lower creatinine and bilirubin levels at the time of ACLF diagnosis and a precipitating factor other than bacterial infection were associated with ACLF reversion at 3-7 days. CONCLUSIONS: ACLF is a frequent complication among patients with chronic liver disease admitted for acute decompensations and is associated with a high mortality rate and is related to the number of organs involved. Bacterial infection is the most frequent precipitating factor of ACLF and probably entails a worse prognosis.

Prevalence and outcomes of acute-on-chronic liver failure among cirrhotic patients admitted for an acute decompensation / Prevalencia y evolución de fracaso hepático crónico agudizado en pacientes cirróticos ingresados por descompensación aguda

Background: Acute-on-chronic liver failure (ACLF) is a common syndrome that occurs in patients with advanced chronic liver disease. It consists of the rapid failure of various organs and is associated with high short-term mortality. We aim to describe the main features and outcomes of inpatients who developed ACLF and to identify the factors associated with in-hospital and 28-day mortality. Patients and methods: All patients meeting ACLF criteria with advanced chronic liver disease admitted for decompensation from January 2014 to December 2016 were identified. Clinical and biological data were collected at the time of ACLF diagnosis and at 3–7 days thereafter, as well as in-hospital and 28-day mortality. Results: Eighty nine out of 354 admission episodes (28%) developed ACLF, which was present at the time of admission in 72% of cases. A precipitating factor was identified in 83% of cases, the most frequent being infection (53%) and gastrointestinal bleeding (19%). In the multivariate regression analysis, the ACLF grade at 3–7 days after diagnosis was predictive of in-hospital mortality and 28-day mortality, and lower creatinine and bilirubin levels at the time of ACLF diagnosis and a precipitating factor other than bacterial infection were associated with ACLF reversion at 3–7 days. Conclusions: ACLF is a frequent complication among patients with chronic liver disease admitted for acute decompensations and is associated with a high mortality rate and is related to the number of organs involved. Bacterial infection is the most frequent precipitating factor of ACLF and probably entails a worse prognosis.(AU)

Introducción: La insuficiencia hepática crónica agudizada (IHCA) es una complicación frecuente en pacientes con enfermedad hepática crónica avanzada. Consiste en el fracaso de varios órganos y se asocia a una elevada mortalidad a corto plazo. El objetivo fue describir las características y evolución de los pacientes ingresados que desarrollan IHCA e identificar los factores asociados con mortalidad intrahospitalaria y a 28 días.Pacientes y métodos: Se identificaron los pacientes que cumplían criterios de IHCA con enfermedad hepática avanzada ingresados por descompensación de Enero 2014 a Diciembre 2016. Se recogieron datos clínicos y analíticos en el momento de presentar IHCA y a los 3-7 días así como mortalidad intrahospitalaria y a los 28 días. Resultados: Ochenta y nueve de 354 ingresos (28%) desarrollaron IHCA, el 72% de los casos IHCA era presente al ingreso. Se identificó un factor precipitante en el 83% de los casos, el más frecuentes fue la infección (53%). En el análisis multivariante, el grado de IHCA a los 3-7 días del diagnóstico se asoció a mortalidad intrahospitalaria y a los 28 días. Niveles de creatinina y bilirrubina en el momento del diagnóstico de IHCA y un factor precipitante distinto de infección bacteriana, se asoció con mejoría del grado de IHCA a los 3-7 días. Conclusiones: IHCA es una complicación frecuente en los pacientes con enfermedad hepática crónica avanzada ingresados por descompensación aguda y se asocia a una elevada mortalidad. Las infecciones bacterianas es el factor precipitante mas frecuente de IHCA y probablemente conlleva un peor pronóstico.(AU)