Impact of compensated cirrhosis on survival in patients with acute-on-chronic liver failure.

Autor: Thanapirom K; Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Thai Red Cross, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Pathumwan, Bangkok, Thailand.; Liver Fibrosis and Cirrhosis Research Unit, Chulalongkorn University, Bangkok, Thailand., Teerasarntipan T; Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Thai Red Cross, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Pathumwan, Bangkok, Thailand., Treeprasertsuk S; Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Thai Red Cross, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Pathumwan, Bangkok, Thailand. battan5410@gmail.com., Choudhury A; Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India., Sahu MK; IMS &SUM Hospital, Bhubaneswar, Odisha, India., Maiwall R; Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Vasant Kunj, New Delhi, India., Pamecha V; Department of Liver Transplantation and Hepato Pancreatico Biliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India., Moreau R; EF Clif, EASL-CLIF Consortium and Grifols Chair, Barcelona, Spain.; Inserm, U1149, Centre de Recherche Sur L'Inflammation (CRI),, Paris, France.; UMRS1149, Université de Paris, Paris, France.; Service d'Hépatologie, Hôpital Beaujon, Assistance Publique-Hôpitaux de Paris, Clichy, France., Al Mahtab M; Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh., Chawla YK; PGIMER, Chandigarh, India., Devarbhavi H; St John's Medical College, Bangalore, India., Yu C; Beijing Youan Hospital and Translational Hepatology Institute, Beijing, China., Ning Q; Tongji Hospital, Tongji Medical College, Wuhan, China., Amarapurkar D; Department of Gastroenterology, Bombay Hospital and Medical Research Centre, Mumbai, India., Eapen CE; CMC, Vellore, India., Hamid SS; Aga Khan University Hospital, Karachi, Pakistan., Butt AS; Aga Khan University Hospital, Karachi, Pakistan., Kim DJ; Hallym University College of Medicine, Chuncheon, South Korea., Lee GH; Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore., Sood A; Dayanand Medical College, Ludhiana, India., Lesmana LA; Digestive Disease & Oncology Centers, Medistra Hospital, Jakarta, Indonesia., Abbas Z; Ziauddin University, Karachi, Pakistan., Shiha G; Egyptian Liver Research Institute and Hospital, Cairo, Egypt., Payawal DA; Cardinal Santos Medical Center, San Jaun, Philippines., Yuen MF; Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong., Chan A; Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong., Lau G; Department of Medicine, Humanity and Health Medical Group, New Kowloon, Hongkong, China., Jia J; Friendship Hospital, Capital University, Beijing, China., Rahman S; Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh., Sharma BC; Department of Hepatology, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India.; Department of Advanced Endoscopy, Institute of Liver and Biliary Sciences, D-1, Acharya Shree Tulsi Marg, Vasant Kunj, New Delhi, 110070, India., Yokosuka O; Chiba University, Chiba, Japan., Sarin SK; Institute of Liver and Biliary Sciences, New Delhi, India.
Jazyk: angličtina
Zdroj: Hepatology international [Hepatol Int] 2022 Feb; Vol. 16 (1), pp. 171-182. Date of Electronic Publication: 2021 Nov 25.
DOI: 10.1007/s12072-021-10266-8
Abstrakt: Background and Aims: Acute-on-chronic liver failure (ACLF) is considered a main prognostic event in patients with chronic liver disease (CLD). We analyzed the 28-day and 90-day mortality in ACLF patients with or without underlying cirrhosis enrolled in the ACLF Research Consortium (AARC) database.
Methods: A total of 1,621 patients were prospectively enrolled and 637 (39.3%) of these patients had cirrhosis. Baseline characteristics, complications and mortality were compared between patients with and without cirrhosis.
Results: Alcohol consumption was more common in cirrhosis than non-cirrhosis (66.4% vs. 44.2%, p < 0.0001), while non-alcoholic fatty liver disease/cryptogenic CLD (10.9% vs 5.8%, p < 0.0001) and chronic HBV reactivation (18.8% vs 11.8%, p < 0.0001) were more common in non-cirrhosis. Only 0.8% of patients underwent liver transplantation. Overall, 28-day and 90-day mortality rates were 39.3% and 49.9%, respectively. Patients with cirrhosis had a greater chance of survival compared to those without cirrhosis both at 28-day (HR = 0.48; 95% CI 0.36-0.63, p < 0.0001) and 90-day (HR = 0.56; 95% CI 0.43-0.72, p < 0.0001), respectively. In alcohol CLD, non-cirrhosis patients had a higher 28-day (49.9% vs. 23.6%, p < 0.001) and 90-day (58.4% vs. 35.2%, p < 0.001) mortality rate than cirrhosis patients. ACLF patients with cirrhosis had longer mean survival than non-cirrhosis patients (25.5 vs. 18.8 days at 28-day and 65.2 vs. 41.2 days at 90-day). Exaggerated systemic inflammation might be the reason why non-cirrhosis patients had a poorer prognosis than those with cirrhosis after ACLF had occurred.
Conclusions: The 28-day and 90-day mortality rates of ACLF patients without cirrhosis were significantly higher than those with cirrhosis in alcoholic CLD. The presence of cirrhosis and its stage should be evaluated at baseline to guide for management. Thai Clinical Trials Registry, TCTR20191226002.
(© 2021. The Author(s).)
Databáze: MEDLINE
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