Acute-on-chronic Liver Failure: Causes, Clinical Characteristics and Predictors of Mortality. | [Journal of College of Physicians and Surgeons--Pakistan : JCPSP • 2017]

Author(s):

1. Abbas Ali Tasneem: Department of Hepato-Gastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan

2. Nasir Hassan Luck: Department of Hepato-Gastroenterology, Sindh Institute of Urology and Transplantation (SIUT), Karachi, Pakistan

Abstract:

Objective: To determine the causes, characteristics and predictors of mortality in patients with acute-on-chronic liver failure (ACLF). Study Design: Cross-sectional study. Place and Duration of Study: Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, from July 2014 to June 2016. Methodology: All patients with acute-on-chronic liver disease (ACLD) with ages > 12 were included. Patients with ACLF, as defined by the Asian Pacific Association for the Study of Liver (APASL, 2014) were identified. Predictors of mortality were identified using chi-square or Fisher's exact test. Results: Included in the study were 72 patients with mean age of 36.71 years, 46 (63.9%) being males. Among them, 61 developed ACLF. Commonest causes of chronic liver disease (CLD) were chronic viral hepatitis (37, 51.4%) and autoimmune hepatitis (14, 19.4%). Commonest causes of acute liver injury (ALI) were acute viral hepatitis (24, 33.3%) and drug induced liver injury (DILI) (17, 23.6%). Among those with ACLF, 24 (39.3%) patients died with median survival of 17.1 ±13.5 days. Mortality was significantly associated with Child Turcotte Pugh (CTP) score =13 (p=0.010), model for end-stage liver disease (MELD) score =30 (p=0.001), age >40 years (p=0.036), organ failures (OF) =3 (p <0.0001), portosystemic encephalopathy (PSE) (p <0.0001), renal failure (p <0.0001) and urosepsis (p <0.0001). Conclusion: Acute viral hepatitis and DILI are commonest causes of ACLF. Mortality is high in ACLF patients having OF =3, CTP =13, MELD =30, age >40 years, PSE, renal failure and urosepsis.

Page(s): 8-12

DOI: DOI not available

Published: Journal: Journal of College of Physicians and Surgeons--Pakistan : JCPSP, Volume: 27, Issue: 1, Year: 2017

Keywords:

Liver failure Acuteonchronic liver failure Acute liver injury Acute viral hepatitis Drug induced liver injury DILI Predictors Mortality

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