O-7 PREVALENCE, CHARACTERIZATION AND SURVIVAL OF ACUTE-ON-CHRONIC LIVER FAILURE IN A CHILEAN UNIVERSITY HOSPITAL

Acute-on-chronic liver failure (ACLF) is a serious clinical entity, with no previous reports in Chile. To characterize patients with ACLF in a Chilean University Hospital, identifying triggers, organ failure and survival at 30, 90, 180 days, compared to patients with decompensated cirrhosis without...

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Published in:Annals of hepatology 2021-09, Vol.24, p.100494, Article 100494
Main Authors: Idalsoaga, Francisco, Valenzuela, Francisco, Díaz Luis, Antonio, Manzur, Franco, Meza, Victor, Sotomayor, Joaquin, Schalper, Maximiliano, Chianale, Franco, Rodríguez, Hernan, Arab Pablo, Juan
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container_title Annals of hepatology
container_volume 24
creator Idalsoaga, Francisco
Valenzuela, Francisco
Díaz Luis, Antonio
Manzur, Franco
Meza, Victor
Sotomayor, Joaquin
Schalper, Maximiliano
Chianale, Franco
Rodríguez, Hernan
Arab Pablo, Juan
description Acute-on-chronic liver failure (ACLF) is a serious clinical entity, with no previous reports in Chile. To characterize patients with ACLF in a Chilean University Hospital, identifying triggers, organ failure and survival at 30, 90, 180 days, compared to patients with decompensated cirrhosis without ACLF. Retrospective cohort study of decompensated cirrhotic patients hospitalized in a chilean University Hospital between 2017-2019. 334 patients were included, 73 (22%) presented ACLF (33% ACLF-1, 30% ACLF-2, 37% ACLF-3); 16.4% underwent liver transplantation. Patients with ACLF were younger, and had higher MELD-Na and APACHE II on admission. The most common triggers in both groups were infections (42.4%), gastrointestinal bleeding (23.2%) and alcohol intake (31.3%). The main organ failures were kidney (60.2%) and brain (49.3%). All organ failures were more frequent in ACLF-3, except renal failure (greater in ACLF-1). Survival at 180 days was 74% in patients without ACLF and 58.3% in ACLF (p=0.004). Mortality was significantly higher in ACLF-2 and ACLF-3, when compared with patients without ACLF (HR 2.3 and 2.99, respectively; p
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To characterize patients with ACLF in a Chilean University Hospital, identifying triggers, organ failure and survival at 30, 90, 180 days, compared to patients with decompensated cirrhosis without ACLF. Retrospective cohort study of decompensated cirrhotic patients hospitalized in a chilean University Hospital between 2017-2019. 334 patients were included, 73 (22%) presented ACLF (33% ACLF-1, 30% ACLF-2, 37% ACLF-3); 16.4% underwent liver transplantation. Patients with ACLF were younger, and had higher MELD-Na and APACHE II on admission. The most common triggers in both groups were infections (42.4%), gastrointestinal bleeding (23.2%) and alcohol intake (31.3%). The main organ failures were kidney (60.2%) and brain (49.3%). All organ failures were more frequent in ACLF-3, except renal failure (greater in ACLF-1). Survival at 180 days was 74% in patients without ACLF and 58.3% in ACLF (p=0.004). Mortality was significantly higher in ACLF-2 and ACLF-3, when compared with patients without ACLF (HR 2.3 and 2.99, respectively; p&lt;0.05). Transplant-free survival in cirrhotics without ACLF was 72.5% versus 43.1% with ACLF (p&lt;0.001). The risk of mortality or transplantation was higher in ACLF-2 and ACLF-3, in contrast to patients without ACLF (HR 2.19 and 4.61, respectively; p &lt;0.05). 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Mortality was significantly higher in ACLF-2 and ACLF-3, when compared with patients without ACLF (HR 2.3 and 2.99, respectively; p&lt;0.05). Transplant-free survival in cirrhotics without ACLF was 72.5% versus 43.1% with ACLF (p&lt;0.001). The risk of mortality or transplantation was higher in ACLF-2 and ACLF-3, in contrast to patients without ACLF (HR 2.19 and 4.61, respectively; p &lt;0.05). 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