| Abstrakt: |
Background: Chronic liver disease (CLD) patients with abrupt deterioration of hepatic function with associated extrahepatic organ failures is defined as acute on chronic liver failure (ACLF). The triggering incidents most common being alcohol followed by drug-induced injury, viral hepatitis, bacterial infections, hypoxia-related injury and major surgical procedures. An acute triggering event inflicts damage upon hepatocytes, leading to the accumulation of inflammatory cytokines leading to cascade of events resulting in further injury to the liver when hepatocyte regeneration fails (liver decompensation), compromised immune function and render them to infections, multi-organ failure, and eventual mortality. Studies regarding in hospital course and mortality for ACLF patients are very few in this region. Hence, this study was conducted to evaluate the clinical profile of ACLF patients, assessment of the in-hospital course, mortality and outcome and to determine the factors affecting the outcome. Materials and Methods: This study was conducted in Regional Institute of Medical Sciences (RIMS), Imphal from May 2022 to July 2024. All patients with chronic liver disease fulfilling the Asian Pacific Association for the Study of Liver criteria for ACLF, admitted in the Department of Medicine, were enrolled. On the day of admission (within 24hours), severity of liver disease was assessed and routine blood investigations, ultrasound whole abdomen, ascitic fluid analysis, upper GI endoscopy were done. Child Pugh Score, Model for End Stage Liver Disease-Na, Sequential Organ Failure Assessment and EASL-CLIF (European Association for the study of Liver-Chronic liver failure) consortium criteria were used. Outcome or mortality were compared among survivors and non - survivors of ACLF.A p value <0.05 was considered significant. Results: A total of 70 ACLF patients were enrolled. The mean age of patients were 45.25±7.9 years with majority being males 63 (89.9%). Jaundice is detected in all patients (100%) and alcohol is the most common etiology of CLD found in 59 patients (84.1%). The most common acute insult precipitating ACLF was bacterial infection (34.3%){Spontaneous bacterial peritonitis followed by active alcoholism (32.9%)}. In our study, anemia and thrombocytopenia were present in 60(85.7%) and 52 (25.7%) patients respectively. Majority of patients belonged to Child Pugh class C (64%). There was significant association between a higher MELD score and mortality (p<0.05), 58 patient (82.6%) survived and 12 (17.4%) died with the mean duration of hospital stay of 11.7±4 days. The most common organ failure was cerebral failure (25.7%) (grade II hepatic encephalopathy). ACLF grade 0,1,2,3 were present in 15(21.7%), 29(42%), and 19 (27.5%) patients respectively. There was significant association between ACLF grade and outcome, 66.7% of the non-survivors were in ACLF grade 3 (p<0.05). Conclusions: Majority of the patients had multi-organ failure at the time of admission (42%) and was significantly associated with mortality (p<0.05). Higher grades of ACLF was associated with higher mortality. Parameters predicting poor outcome are low hemoglobin and platelet, high total leucocyte count, low serum albumin, elevated creatinine and high INR. Therefore, better characterization of the disease, vital signs and organ function will help in improving the patients' outcome and early implementation of organ-specific interventions. [ABSTRACT FROM AUTHOR] |
