Diagnostics (Dec 2023)

The Clinical Courses and Prognosis of Cirrhotic Patients after First Acute Decompensation: Prospective Cohort Study

  • Jung Hee Kim,
  • Sung-Eun Kim,
  • Do Seon Song,
  • Hee Yeon Kim,
  • Eileen L. Yoon,
  • Seong Hee Kang,
  • Young-Kul Jung,
  • Jung Hyun Kwon,
  • Sung Won Lee,
  • Seul Ki Han,
  • Young Chang,
  • Soung Won Jeong,
  • Jeong Ju Yoo,
  • Young-Joo Jin,
  • Gab Jin Cheon,
  • Byung Seok Kim,
  • Yeon Seok Seo,
  • Hyoungsu Kim,
  • Ji Won Park,
  • Tae Hyung Kim,
  • Dong Hyun Sinn,
  • Woo Jin Chung,
  • Hwi Young Kim,
  • Han Ah Lee,
  • Seung Woo Nam,
  • In Hee Kim,
  • Ji Hoon Kim,
  • Hee Bok Chae,
  • Joo Hyun Sohn,
  • Ju Yeon Cho,
  • Jung Gil Park,
  • Hyun Chin Cho,
  • Yoon Jun Kim,
  • Jin Mo Yang,
  • Ki Tae Suk,
  • Moon Young Kim,
  • Sang Gyune Kim,
  • Hyung Joon Yim,
  • Won Kim,
  • Jae-Young Jang,
  • Dong Joon Kim

DOI
https://doi.org/10.3390/diagnostics14010014
Journal volume & issue
Vol. 14, no. 1
p. 14

Abstract

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Background: The European Foundation for the Study of Chronic Liver Failure (EF-CLIF) consortium suggested that the clinical courses after acute decompensation (AD) stratify the long-term prognosis: stable decompensated cirrhosis (SDC), unstable decompensated cirrhosis (UDC), pre acute-on-chronic liver failure (pre ACLF), and ACLF. However, previous studies included patients with a history of previous AD and had limitations associated with identifying the clinical factors related to prognosis after the first AD. Method: The prospective Korean Acute-on-Chronic Liver Failure (KACLiF) cohort included cirrhotic patients who were hospitalised with first AD between July 2015 and August 2018. We analysed the factors associated with readmission after the first AD and compared the characteristics and prognosis among each subgroup to evaluate the risk factors for the occurrence of pre ACLF after AD. Result: A total of 746 cirrhotic patients who were hospitalised with first AD were enrolled. The subgroups consisted of SDC (n = 565), UDC (n = 29), pre ACLF (n = 28), and ACLF (n = 124). Of note, pre ACLF showed a poorer prognosis than ACLF. The risk factors associated with readmission within 3 months of first AD were non-variceal gastrointestinal (GI) bleeding, hepatic encephalopathy (HE), and high MELD score. Viral aetiology was associated with the occurrence of pre ACLF compared with alcohol aetiology regardless of baseline liver function status. Conclusion: Cirrhotic patients with first AD who present as non-variceal GI bleeding and HE can easily relapse. Interestingly, the occurrence of AD with organ failure within 3 months of first AD (pre ACLF) has worse prognosis compared with the occurrence of organ failure at first AD (ACLF). In particular, cirrhotic patients with viral hepatitis with/without alcohol consumption showed poor prognosis compared to other aetiologies. Therefore, patients with ACLF after AD within 3 months should be treated more carefully and definitive treatment through LT should be considered.

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