Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis - PubMed (original) (raw)

Observational Study

doi: 10.1002/hep.27849. Epub 2015 May 29.

Javier Fernandez 2, Elisabet Garcia 3, Filippo Morando 4, Paolo Caraceni 5, Carlo Alessandria 6, Wim Laleman 7, Jonel Trebicka 8, Laure Elkrief 9, Corinna Hopf 10, Pablo Solís-Munoz 11, Faouzi Saliba 12, Stefan Zeuzem 13, Augustin Albillos 14, Daniel Benten 15, José Luis Montero-Alvarez 16, Maria Teresa Chivas 17, Mar Concepción 18, Juan Córdoba 19, Aiden McCormick 20, Rudolf Stauber 21, Wolfgang Vogel 22, Andrea de Gottardi 23, Tania M Welzel 13, Marco Domenicali 5, Alessandro Risso 6, Julia Wendon 11, Carme Deulofeu 3, Paolo Angeli 4, François Durand 9, Marco Pavesi 3, Alexander Gerbes 10, Rajiv Jalan 24, Richard Moreau 9, Pere Ginés 2, Mauro Bernardi 25, Vicente Arroyo 25; CANONIC Study Investigators of the EASL-CLIF Consortium

Collaborators, Affiliations

Observational Study

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

Thierry Gustot et al. Hepatology. 2015 Jul.

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.

© 2015 by the American Association for the Study of Liver Diseases.

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