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The prognostic value of acute-on-chronic liver failure during the course of severe alcoholic hepatitis

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eMediNexus    15 January 2022

Identification of the more suitable factors predicting death is needed in alcoholic hepatitis (AH). Acute-on-chronic liver failure (ACLF) is often encountered during ongoing liver disease, which can be recognized when AH is diagnosed (prevalent ACLF [pACLF]) or during follow-up (incidental ACLF [iACLF]). A study analyzed the effect of ACLF on outcomes in AH and the association between infection and onset of ACLF and death.

The study enrolled the patients suffering from biopsy-proven severe (s)AH with a Maddrey discriminant function (mDF) ≥32. They underwent evaluation for Infectious episodes, ACLF, and mortality during a 168-day follow-up period. The obtained results were validated on an independent cohort.

The following observations were made-

  • The study enrolled 165 patients. 
  • 66.3 ± 20.7 was the mean mDF and 26.8 ± 7.4 was the mean model for end-stage liver disease score. 
  • The 28-day cumulative incidence of death (CID) was found to be 31%. 
  • 47.9% of patients demonstrated the presence of pACLF. 
  • The 28-day CID without pACLF and with pACLF-1, pACLF-2, and pACLF-3 were found to be 10.4%, 30.8% , 58.3%, and 72.4%, respectively. 
  • 17.5% of the patients developed iACLF. 
  • The 28-day relative risk of death in patients acquiring iACLF was found to be 41.87. 
  • Follow-up showed A previous infection to be the only independent risk factor for developing iACLF. 
  • These data were confirmed in a validation cohort of 97 patients with probable sAH.

Thus, ACLF was found to be often present during the course of sAH, associated with high mortality. The presence of an infection intensely predicts the initiation of ACLF in this setting.

SOURCE- Sersté T, Cornillie A, Njimi H, Pavesi M, Arroyo V, Putignano A, Weichselbaum L, Deltenre P, Degré D, Trépo E, Moreno C, Gustot T. The prognostic value of acute-on-chronic liver failure during the course of severe alcoholic hepatitis, Journal of Hepatology, 2018;69(2):318-324. https://doi.org/10.1016/j.jhep.2018.02.022.

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