Characteristics and outcomes of chronic liver disease patients with acute deteriorated liver function by severity of underlying liver disease.
AIM
To analyze characteristics and outcome of patients with acute-on-chronic liver failure (ACLF) according to the severity of underlying liver disease.


METHODS
One hundred and sixty-seven adult patients with chronic liver disease and acute deteriorated liver function, defined by jaundice and coagulopathy, were analyzed. Predisposition, type of injury, response, organ failure, and survival were analyzed and compared between patients with non-cirrhosis (type A), cirrhosis (type B) and cirrhosis with previous decompensation (type C).


RESULTS
The predisposition was mostly hepatitis B in type A, while it was alcoholic liver disease in types B and C. Injury was mostly hepatic in type A, but was non-hepatic in type C. Liver failure, defined by CLIF-SOFA, was more frequent in types A and B, and circulatory failure was more frequent in type C. The 30-d overall survival rate (85.3%, 81.1% and 83.7% for types A, B and C, respectively, P = 0.31) and the 30-d transplant-free survival rate (55.9%, 65.5% and 62.5% for types A, B and C, respectively P = 0.33) were not different by ACLF subtype, but 1-year overall survival rate were different (85.3%, 71.7% and 58.7% for types A, B and C, respectively, P = 0.02).


CONCLUSION
There were clear differences in predisposition, type of injury, accompanying organ failure and long-term mortality according to spectrum of chronic liver disease, implying classifying subtype according to the severity of underlying liver disease is useful for defining, clarifying and comparing ACLF.
['Hong|Yun Soo|YS|', 'Sinn|Dong Hyun|DH|', 'Gwak|Geum-Youn|GY|', 'Cho|Juhee|J|', 'Kang|Danbee|D|', 'Paik|Yong-Han|YH|', 'Choi|Moon Seok|MS|', 'Lee|Joon Hyeok|JH|', 'Koh|Kwang Cheol|KC|', 'Paik|Seung Woon|SW|']
D065290:Acute-On-Chronic Liver Failure D000328:Adult D000368:Aged D018450:Disease Progression D005260:Female D019694:Hepatitis B, Chronic D019698:Hepatitis C, Chronic D019693:Hepatitis, Autoimmune D006801:Humans D053208:Kaplan-Meier Estimate D008103:Liver Cirrhosis D008108:Liver Diseases, Alcoholic D008111:Liver Function Tests D016031:Liver Transplantation D008297:Male D008875:Middle Aged D063305:Organ Dysfunction Scores D011237:Predictive Value of Tests D011379:Prognosis D012189:Retrospective Studies D012307:Risk Factors D012720:Severity of Illness Index D013997:Time Factors
Injury Organ failure Survival Acute-on chronic liver failure Classification