Profile of Patients Admitted with Acute-on-Chronic Liver Disease in a Tertiary Care Hospital Bal Kishan Gupta, Shyam Lal Meena, Vijay Kumar Meena; Jigyasa Gupta

Abstract

Introduction: Chronic liver disease (CLD) and cirrhosis of liver are 12th leading cause of death. Acute-on-chronic liver failure (ACLF) is an increasingly recognized entity encompassing an acute deterioration of liver function in patients with cirrhosis and it is associated with high mortality. Methodology: A total of 100 consecutive patients admitted with ACLF were studied. Chronic liver disease was defined as per 2014 ICD-10 CM Diagnosis Code K 76.9. ACLF was defined as per the Asian Pacific Association for the Study of the Liver (APASL) criteria. Grading of severity of ACLF was done as per the CANONIC study. Prognostic scores including Child- Pugh scoring system were also calculated. Results: Out of 100 patients 84 were males (mean age 44.31±13.58 years) and 16 females (mean age 40.19±19.11 years). Underlying etiology of CLD was alcoholic (76 cases), Hepatitis B virus (HBV) (10 cases), cryptogenic (seven cases), autoimmune (four cases) and Heapatitis C virus (HCV) in (three cases). There were 74% from rural area, 51% illiterate and 82% belonged to the low socio-economic status. Most common presentation of ACLF was hemetemesis (36%) followed by melena (30%), vomiting (30%), sepsis (28%), pain abdomen (27%), hepatic encephalopathy (17%) and hepato-renal syndrome (16%). Mortality rate in our study was 9% and all belonged to the alcoholic group. Severe anemia, hypoalbuminemia, hyperbilirubinemia, renal dysfunction, sepsis, hyponatremia, high PT-INR and high Child Pugh score 10-15 were associated with poor prognosis. Conclusion: Knowledge and early recognition of various risk factors may help in prevention of acute- on- chronic liver failure and early identification of various prognostic features may help in decreasing the mortality in patients of acute-on-chronic liver failure.

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