Acute-On-Chronic Liver Failure Defined by Asian Pacific Association for the Study of the Liver Should Include Decompensated Cirrhosis
Background and Aims: Acute-on-chronic liver failure (ACLF) is an acute deterioration of chronic liver disease with high short-term mortality. The inclusion or exclusion of previously decompensated cirrhosis (DC) in the diagnostic criteria of ACLF defined by the Asian Pacific Association for the Stud...
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| Format: | Article |
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Frontiers Media S.A.
2021-10-01
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| Series: | Frontiers in Medicine |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fmed.2021.750061/full |
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| author | Manman Xu Manman Xu Ming Kong Ming Kong Pengfei Yu Pengfei Yu Yingying Cao Fang Liu Bing Zhu Yizhi Zhang Yizhi Zhang Wang Lu Wang Lu Huaibin Zou Huaibin Zou Shaoli You Shaojie Xin Zhongping Duan Zhongping Duan Tao Han Yu Chen Yu Chen |
| author_facet | Manman Xu Manman Xu Ming Kong Ming Kong Pengfei Yu Pengfei Yu Yingying Cao Fang Liu Bing Zhu Yizhi Zhang Yizhi Zhang Wang Lu Wang Lu Huaibin Zou Huaibin Zou Shaoli You Shaojie Xin Zhongping Duan Zhongping Duan Tao Han Yu Chen Yu Chen |
| author_sort | Manman Xu |
| collection | DOAJ |
| description | Background and Aims: Acute-on-chronic liver failure (ACLF) is an acute deterioration of chronic liver disease with high short-term mortality. The inclusion or exclusion of previously decompensated cirrhosis (DC) in the diagnostic criteria of ACLF defined by the Asian Pacific Association for the Study of the Liver (APASL-ACLF) has not been conclusive. We aimed to evaluate the prognostic impact of decompensated cirrhosis in ACLF.Methods: We retrospectively collected a cohort of patients with a diagnosis of APASL-ACLF (with or without DC) hospitalized from 2012 to 2020 at three liver units in tertiary hospitals. Baseline characteristics and survival data at 28, 90, 180, 360, 540, and 720 days were collected.Results: Of the patients assessed using APASL-ACLF criteria without the diagnostic indicator of chronic liver disease, 689 patients were diagnosed with ACLF, of whom 435 had no decompensated cirrhosis (non-DC-ACLF) and 254 had previously decompensated cirrhosis (DC-ACLF). The 28-, 90-, 180-, 360-, 540-, and 720-day mortality were 24.8, 42.9, 48.7, 57.3, 63.4, and 68.1%, respectively, in DC-ACLF patients, which were significantly higher than in non-DC-ACLF patients (p < 0.05). DC was independently associated with long-term (180/360/540/720 days) but not short-term (28/90 days) mortality in patients with ACLF. Age, total bilirubin, international normalized ratio, and hepatic encephalopathy were independent risk factors for short- and long-term mortality risk in ACLF patients (p < 0.05).Conclusions: Patients with DC-ACLF have a higher mortality rate, especially long-term mortality, compared to non-DC-ACLF patients. Therefore, DC should be included in the diagnostic criteria of APASL-ACLF and treated according to the ACLF management process. |
| first_indexed | 2024-12-17T21:28:01Z |
| format | Article |
| id | doaj.art-1fb61c2465274f8daf81fae7f634895f |
| institution | Directory Open Access Journal |
| issn | 2296-858X |
| language | English |
| last_indexed | 2024-12-17T21:28:01Z |
| publishDate | 2021-10-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Medicine |
| spelling | doaj.art-1fb61c2465274f8daf81fae7f634895f2022-12-21T21:31:59ZengFrontiers Media S.A.Frontiers in Medicine2296-858X2021-10-01810.3389/fmed.2021.750061750061Acute-On-Chronic Liver Failure Defined by Asian Pacific Association for the Study of the Liver Should Include Decompensated CirrhosisManman Xu0Manman Xu1Ming Kong2Ming Kong3Pengfei Yu4Pengfei Yu5Yingying Cao6Fang Liu7Bing Zhu8Yizhi Zhang9Yizhi Zhang10Wang Lu11Wang Lu12Huaibin Zou13Huaibin Zou14Shaoli You15Shaojie Xin16Zhongping Duan17Zhongping Duan18Tao Han19Yu Chen20Yu Chen21Fourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, ChinaBeijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, ChinaFourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, ChinaBeijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, ChinaFourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, ChinaBeijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, ChinaDepartment of Hepatology, Third Central Hospital of Tianjin, Tianjin, ChinaDepartment of Hepatology, Third Central Hospital of Tianjin, Tianjin, ChinaLiver Failure Treatment and Research Center, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, ChinaFourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, ChinaBeijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, ChinaFourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, ChinaBeijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, ChinaFourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, ChinaBeijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, ChinaLiver Failure Treatment and Research Center, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, ChinaLiver Failure Treatment and Research Center, The Fifth Medical Center of Chinese People's Liberation Army (PLA) General Hospital, Beijing, ChinaFourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, ChinaBeijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, ChinaDepartment of Hepatology, Third Central Hospital of Tianjin, Tianjin, ChinaFourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, ChinaBeijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, ChinaBackground and Aims: Acute-on-chronic liver failure (ACLF) is an acute deterioration of chronic liver disease with high short-term mortality. The inclusion or exclusion of previously decompensated cirrhosis (DC) in the diagnostic criteria of ACLF defined by the Asian Pacific Association for the Study of the Liver (APASL-ACLF) has not been conclusive. We aimed to evaluate the prognostic impact of decompensated cirrhosis in ACLF.Methods: We retrospectively collected a cohort of patients with a diagnosis of APASL-ACLF (with or without DC) hospitalized from 2012 to 2020 at three liver units in tertiary hospitals. Baseline characteristics and survival data at 28, 90, 180, 360, 540, and 720 days were collected.Results: Of the patients assessed using APASL-ACLF criteria without the diagnostic indicator of chronic liver disease, 689 patients were diagnosed with ACLF, of whom 435 had no decompensated cirrhosis (non-DC-ACLF) and 254 had previously decompensated cirrhosis (DC-ACLF). The 28-, 90-, 180-, 360-, 540-, and 720-day mortality were 24.8, 42.9, 48.7, 57.3, 63.4, and 68.1%, respectively, in DC-ACLF patients, which were significantly higher than in non-DC-ACLF patients (p < 0.05). DC was independently associated with long-term (180/360/540/720 days) but not short-term (28/90 days) mortality in patients with ACLF. Age, total bilirubin, international normalized ratio, and hepatic encephalopathy were independent risk factors for short- and long-term mortality risk in ACLF patients (p < 0.05).Conclusions: Patients with DC-ACLF have a higher mortality rate, especially long-term mortality, compared to non-DC-ACLF patients. Therefore, DC should be included in the diagnostic criteria of APASL-ACLF and treated according to the ACLF management process.https://www.frontiersin.org/articles/10.3389/fmed.2021.750061/fullAsian Pacific Association for the Study of the Liver (APASL)acute-on-chronic liver failure (ACLF)diagnostic indicatormortalitydecompensated cirrhosis |
| spellingShingle | Manman Xu Manman Xu Ming Kong Ming Kong Pengfei Yu Pengfei Yu Yingying Cao Fang Liu Bing Zhu Yizhi Zhang Yizhi Zhang Wang Lu Wang Lu Huaibin Zou Huaibin Zou Shaoli You Shaojie Xin Zhongping Duan Zhongping Duan Tao Han Yu Chen Yu Chen Acute-On-Chronic Liver Failure Defined by Asian Pacific Association for the Study of the Liver Should Include Decompensated Cirrhosis Frontiers in Medicine Asian Pacific Association for the Study of the Liver (APASL) acute-on-chronic liver failure (ACLF) diagnostic indicator mortality decompensated cirrhosis |
| title | Acute-On-Chronic Liver Failure Defined by Asian Pacific Association for the Study of the Liver Should Include Decompensated Cirrhosis |
| title_full | Acute-On-Chronic Liver Failure Defined by Asian Pacific Association for the Study of the Liver Should Include Decompensated Cirrhosis |
| title_fullStr | Acute-On-Chronic Liver Failure Defined by Asian Pacific Association for the Study of the Liver Should Include Decompensated Cirrhosis |
| title_full_unstemmed | Acute-On-Chronic Liver Failure Defined by Asian Pacific Association for the Study of the Liver Should Include Decompensated Cirrhosis |
| title_short | Acute-On-Chronic Liver Failure Defined by Asian Pacific Association for the Study of the Liver Should Include Decompensated Cirrhosis |
| title_sort | acute on chronic liver failure defined by asian pacific association for the study of the liver should include decompensated cirrhosis |
| topic | Asian Pacific Association for the Study of the Liver (APASL) acute-on-chronic liver failure (ACLF) diagnostic indicator mortality decompensated cirrhosis |
| url | https://www.frontiersin.org/articles/10.3389/fmed.2021.750061/full |
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