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Hepatology. 2015 Jul;62(1):243-52. doi: 10.1002/hep.27849. Epub 2015 May 29.

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

Author information

1
Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium.
2
Hospital Clínic, Barcelona, Spain.
3
Data Management Center of the EASL-CLIF Consortium, CIBEReHD, Barcelona, Spain.
4
University of Padova, Padova, Italy.
5
Policlinico St Orsola Malpighi, Bologna, Italy.
6
University of Turin, Turin, Italy.
7
University Hospital Gasthuisberg, Leuven, Belgium.
8
University Hospital Bonn, Bonn, Germany.
9
Hôpital Beaujon, Clichy, France.
10
University of Munich, Klinikum der LMU, Munich, Germany.
11
Kinǵs College Hospital, London, London, UK.
12
Hopital Paul Brousse, Villejuif, France.
13
J.W. Goethe University Hospital, Frankfurt, Germany.
14
Hospital Ramón y Cajal, Madrid, Spain.
15
University Hospital Hambourg-Eppendorf, Germany.
16
Reina Sofía University Hospital, Córdoba, Spain.
17
Hospital Gregorio Marañón, Madrid, Spain.
18
Hospital de la Santa Creu i Sant Pau, Barcelona, Spain.
19
Hospital Vall d'Hebron, Barcelona, Spain.
20
St Vincent's University Hospital, Dublin, Ireland.
21
Medical University of Graz, Graz, Austria.
22
Medical University of Innsbruck, Innsbruck, Austria.
23
University of Berne, Berne, Switzerland.
24
Royal Free Hospital, London, UK.
25
EASL-CLIF Consortium, Barcelona, Spain.

Abstract

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.

PMID:
25877702
DOI:
10.1002/hep.27849
[Indexed for MEDLINE]
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