Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit
Introduction and Objectives: Acute on Chronic Liver Failure (ACLF) is characterized by organ failure and high 28-day mortality. Identifying clinical predictors associated with early mortality could have implications for the treatment of patients with ACLF. Patients and methods: Patients diagnosed wi...
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| Format: | Article |
| Language: | English |
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Elsevier
2021-05-01
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| Series: | Annals of Hepatology |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S166526812030185X |
| _version_ | 1818458230822535168 |
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| author | Osvely Méndez-Guerrero Daniel A. Calle-Rodas Eduardo Cervantes-Alvarez Elisa Alatorre-Arenas Juanita Pérez-Escobar Nalu Navarro-Alvarez Aldo Torre |
| author_facet | Osvely Méndez-Guerrero Daniel A. Calle-Rodas Eduardo Cervantes-Alvarez Elisa Alatorre-Arenas Juanita Pérez-Escobar Nalu Navarro-Alvarez Aldo Torre |
| author_sort | Osvely Méndez-Guerrero |
| collection | DOAJ |
| description | Introduction and Objectives: Acute on Chronic Liver Failure (ACLF) is characterized by organ failure and high 28-day mortality. Identifying clinical predictors associated with early mortality could have implications for the treatment of patients with ACLF. Patients and methods: Patients diagnosed with chronic liver failure that developed ACLF based on the EASL-CLIF Consortium definition admitted to the Intensive care unit of a tertiary hospital between 2012–2018 were included. Bivariate and multivariate Cox regression analyses were performed to identify factors associated with mortality. Results: 148 patients (55% female) were diagnosed with ACLF of which 55% (n = 82) had ACLF grade 3, 28% (n = 41) grade 2 and 17% (n = 25) grade 1. The median age was 54 years (41-63). Hepatitis C virus (HCV) was the most frequent etiology in 29.8% (n = 44) of the patients with bacterial infection being the most predominant precipitant factor in 58.1% (n = 86). Ninety-day global cumulative survival was only 18%. When divided by grade, mortality reached to 10% in ACLF 3. Moreover, in the multivariate Cox regression analysis, renal failure (HR 3.26, 95% CI (2.13–4.99), brain failure (HR 1.37, 95% CI 1.09–2.04) and male sex (HR 1.62, 95% CI 1.10–2.40) were independent predictors of 28- and 90-day mortality. Conclusions: ACLF is a frequent syndrome among chronic liver disease patients. Brain and renal failure are significantly associated with higher mortality and are independent predictors of 28 and 90-day mortality. |
| first_indexed | 2024-12-14T22:55:10Z |
| format | Article |
| id | doaj.art-66703e816c284a1c83511133b4d2bf82 |
| institution | Directory Open Access Journal |
| issn | 1665-2681 |
| language | English |
| last_indexed | 2024-12-14T22:55:10Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Annals of Hepatology |
| spelling | doaj.art-66703e816c284a1c83511133b4d2bf822022-12-21T22:44:36ZengElsevierAnnals of Hepatology1665-26812021-05-0122100270Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unitOsvely Méndez-Guerrero0Daniel A. Calle-Rodas1Eduardo Cervantes-Alvarez2Elisa Alatorre-Arenas3Juanita Pérez-Escobar4Nalu Navarro-Alvarez5Aldo Torre6Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, MexicoInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, MexicoInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico; PECEM, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City, MexicoInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, MexicoInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, MexicoInstituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico; Universidad Panamericana School of Medicine, Campus México, Mexico City, Mexico; Department of Surgery, University of Colorado Anschutz Medical Campus, Denver, CO, United States; Corresponding authors.Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Department of Gastroenterology, Mexico City, Mexico; Corresponding authors.Introduction and Objectives: Acute on Chronic Liver Failure (ACLF) is characterized by organ failure and high 28-day mortality. Identifying clinical predictors associated with early mortality could have implications for the treatment of patients with ACLF. Patients and methods: Patients diagnosed with chronic liver failure that developed ACLF based on the EASL-CLIF Consortium definition admitted to the Intensive care unit of a tertiary hospital between 2012–2018 were included. Bivariate and multivariate Cox regression analyses were performed to identify factors associated with mortality. Results: 148 patients (55% female) were diagnosed with ACLF of which 55% (n = 82) had ACLF grade 3, 28% (n = 41) grade 2 and 17% (n = 25) grade 1. The median age was 54 years (41-63). Hepatitis C virus (HCV) was the most frequent etiology in 29.8% (n = 44) of the patients with bacterial infection being the most predominant precipitant factor in 58.1% (n = 86). Ninety-day global cumulative survival was only 18%. When divided by grade, mortality reached to 10% in ACLF 3. Moreover, in the multivariate Cox regression analysis, renal failure (HR 3.26, 95% CI (2.13–4.99), brain failure (HR 1.37, 95% CI 1.09–2.04) and male sex (HR 1.62, 95% CI 1.10–2.40) were independent predictors of 28- and 90-day mortality. Conclusions: ACLF is a frequent syndrome among chronic liver disease patients. Brain and renal failure are significantly associated with higher mortality and are independent predictors of 28 and 90-day mortality.http://www.sciencedirect.com/science/article/pii/S166526812030185XACLFMortality predictorsBrain failureRenal failureMexico |
| spellingShingle | Osvely Méndez-Guerrero Daniel A. Calle-Rodas Eduardo Cervantes-Alvarez Elisa Alatorre-Arenas Juanita Pérez-Escobar Nalu Navarro-Alvarez Aldo Torre Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit Annals of Hepatology ACLF Mortality predictors Brain failure Renal failure Mexico |
| title | Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit |
| title_full | Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit |
| title_fullStr | Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit |
| title_full_unstemmed | Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit |
| title_short | Renal and brain failure predict mortality of patients with acute-on-chronic liver failure admitted to the intensive care unit |
| title_sort | renal and brain failure predict mortality of patients with acute on chronic liver failure admitted to the intensive care unit |
| topic | ACLF Mortality predictors Brain failure Renal failure Mexico |
| url | http://www.sciencedirect.com/science/article/pii/S166526812030185X |
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