PLoS ONE (Jan 2016)

Characteristics and Discrepancies in Acute-on-Chronic Liver Failure: Need for a Unified Definition.

  • Tae Yeob Kim,
  • Do Seon Song,
  • Hee Yeon Kim,
  • Dong Hyun Sinn,
  • Eileen L Yoon,
  • Chang Wook Kim,
  • Young Kul Jung,
  • Ki Tae Suk,
  • Sang Soo Lee,
  • Chang Hyeong Lee,
  • Tae Hun Kim,
  • Jeong Han Kim,
  • Won Hyeok Choe,
  • Hyung Joon Yim,
  • Sung Eun Kim,
  • Soon Koo Baik,
  • Byung Seok Lee,
  • Jae Young Jang,
  • Jeong Suh,
  • Hyoung Su Kim,
  • Seong Woo Nam,
  • Hyeok Choon Kwon,
  • Young Seok Kim,
  • Sang Gyune Kim,
  • Hee Bok Chae,
  • Jin Mo Yang,
  • Joo Hyun Sohn,
  • Heon Ju Lee,
  • Seung Ha Park,
  • Byung Hoon Han,
  • Eun Hee Choi,
  • Chang H Kim,
  • Dong Joon Kim,
  • Korean Acute-on-Chronic Liver Failure Study Group

DOI
https://doi.org/10.1371/journal.pone.0146745
Journal volume & issue
Vol. 11, no. 1
p. e0146745

Abstract

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To investigate the prevalence, mortalities, and patient characteristics of Acute-on-chronic liver failure (ACLF) according to the AARC (Asian Pacific Association for the Study of the Liver ACLF Research Consortium) and European Association for the Study of the Liver CLIF-C (Chronic Liver Failure Consortium) definitions.We collected retrospective data for 1470 hospitalized patients with chronic liver disease (CLD) and acute deterioration between January 2013 and December 2013 from 21 university hospitals in Korea.Of the patients assessed, the prevalence of ACLF based on the AARC and CLIF-C definitions was 9.5% and 18.6%, respectively. The 28-day and 90-day mortality rates were higher in patients with ACLF than in those without ACLF. Patients who only met the CLIF-C definition had significantly lower 28-day and 90-day survival rates than those who only met the AARC definition (68.0% vs. 93.9%, P<0.001; 55.1% vs. 92.4%, P<0.001). Among the patients who had non-cirrhotic CLD, the 90-day mortality of the patients with ACLF was higher than of those without ACLF, although not significant (33.3% vs. 6.0%, P = 0.192). Patients with previous acute decompensation (AD) within 1- year had a lower 90-day survival rate than those with AD more than 1 year prior or without previous AD (81.0% vs. 91.9% or 89.4%, respectively, all P<0.001). Patients who had extra-hepatic organ failure without liver failure had a similar 90-day survival rate to those who had liver failure as a prerequisite (57.0% vs. 60.6%, P = 0.391).The two ACLF definitions result in differences in mortality and patient characteristics among ACLF patients. We suggest that non-cirrhotic CLD, previous AD within 1 year, and extra-hepatic organ failure should be included in the ACLF diagnostic criteria. In addition, further studies are necessary to develop a universal definition of ACLF.