Annals of Hepatology (Dec 2024)

OP-5 ACUTE-ON-CHRONIC LIVER FAILURE (ACLF) CRITERIA IN ALCOHOL-ASSOCIATED HEPATITIS: IMPLICATIONS FOR LIVER TRANSPLANTATION

  • LUIS ANTONIO DÍAZ PIGA,
  • Paula Huerta,
  • Renata Farias,
  • Bastian Alcayaga,
  • Francisco Idalsoaga,
  • Gustavo Ayares,
  • Jorge Arnold,
  • María Ayala-Valverde,
  • Diego Perez,
  • Jaime Gomez,
  • Rodrigo Escarate,
  • Eduardo Fuentes-López,
  • Katherine Maldonado,
  • Juan Pablo Roblero,
  • Daniela Simian,
  • Blanca Norero,
  • Raul Lazarte,
  • José Antonio Velarde,
  • Jacqueline Córdova,
  • Fátima Higuera-de-la-Tijera,
  • Alfredo Servin-Caamaño,
  • Jesús Varela,
  • Scherezada Mejía Loza,
  • Rita Silva,
  • Cristina Melo Rocha,
  • Roberta C. Araujo,
  • Gustavo Henrique Pereira,
  • Claudia Alves Couto,
  • Fernando Bessone,
  • Mario Tanno,
  • Gustavo Romero,
  • Manuel Mendizabal,
  • Sebastián Marciano,
  • Gonzalo Gomez Perdiguero,
  • Melisa Dirchwolf,
  • Pedro Montes,
  • Patricia Guerra Salazar,
  • Geraldine Ramos,
  • Susana Castro Sánchez,
  • Juan Carlos Restrepo,
  • Enrique Carrera,
  • Mayur Brahmania,
  • Ashwani K. Singal,
  • Winston Dunn,
  • Ramon Bataller,
  • Vijay Shah,
  • Patrick S. Kamath,
  • Marco Arrese,
  • Juan Pablo Arab

Journal volume & issue
Vol. 29
p. 101603

Abstract

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Conflict of interest: No Introduction and Objectives: Background: Severe alcohol-associated hepatitis (AH) is considered a common precipitant of acute-on-chronic liver failure (ACLF). This study aims to characterize the association between AH and ACLF, focusing on mortality across different ACLF grades. Patients / Materials and Methods: Multicenter prospective cohort study. We included patients admitted with severe AH between 2015–2022. The main outcome was mortality by ACLF grade during admission. The analysis included survival analysis using Cox regression. We adjusted multivariable models based on the main predictors of mortality observed in prior studies. Results and Discussion: We prospectively included 646 patients from 24 centers and 8 countries. Age 49.9±11.7 years, 85.1% of men and 64.4% had a previous diagnosis of cirrhosis. Median MELD at admission was 25 [20-31] points, 46.5% of patients were treated with corticosteroids, and only 2.2% underwent liver transplantation (LT). Around 67.4% of patients fulfilled ACLF criteria: 10.1% grade 1, 19.2% grade 2, and 38.1% grade 3. The most frequent organ dysfunctions were 76.2% liver, 40.8% brain, 43.2% coagulation, 29.6% renal, 29.4% circulatory, and 18.9% lung failure. Survival at 180 days was 77.8% (95%CI: 72.1-82.6%) in those without ACLF grade 3 and 28.0% (95%CI: 20.5–36.0%) in those with ACLF grade 3 (p<0.001). In the multivariable model adjusted by age, body mass index, and MELD score, individuals with ACLF grade 3 had lower survival than those without ACLF (HR 2.67, 95%CI: 1.50–4.76; p=0.001). However, those with ACLF grade 1 (HR 1.50, 95%CI: 0.76–2.96; p=0.243) and grade 2 (HR 0.70, 95%CI: 0.31–1.56; p=0.380) were not associated with a higher mortality than those without ACLF. Conclusions: Among patients with AH, only ACLF grade 3 is a major determinant of morbimortality. Thus, patients who fulfill ACLF grade 3 should promptly be referred for early LT. The redefinition of ACLF in AH is essential for better quantifying the severity and determining therapeutic goals.