P-13 PREVALENCE, CHARACTERIZATION, AND SURVIVAL OF ACUTE ON CHRONIC LIVER FAILURE IN A LATIN AMERICAN COHORT:  A MULTICENTER STUDY

Abstract

Introduction and Objectives: Acute-on-chronic liver failure (ACLF) is a severe clinical entity with organ failures and high short-term mortality. To Date, few ACLF reports have been published in Latin America. This study aimed to characterize patients with ACLF, identifying triggers, organ failure, and survival at 30, 90, and 180 days compared to patients with decompensated cirrhosis without ACLF. Materials and Methods: Retrospective study of decompensated cirrhotic patients hospitalized (between 2017-2019) in three centers in Chile. We evaluated transplant-free survival using Kaplan-Meier curves and Cox-regression. Results: 398 patients were included, a median age of 65.3±11.7-year-old, 50.5% female, 91 (22.9%) presented ACLF (8% ACLF-1, 6.3% ACLF-2, 8.6% ACLF-3); 6.6% underwent liver transplantation. ACLF patients were younger (63.6 vs. 66.0 years; p=0.045), had higher MELD-Na scores (27 [23-32] vs. 17 [13-23]; p<0.001) and higher APACHE II scores (20.5 [16-25] vs. 14 [10-15]; p<0.001) at admission. The most common triggers in both groups were infections (42.4%), gastrointestinal bleeding (23.2%), and alcohol intake (31.3%). Among decompensating factors, acute kidney injury at admission was associated with higher mortality (HR 2.2, 95%CI: 1.4-3.4; p<0.001). The main organ failures were kidney (60.4%), circulatory (49.5%), and brain (48.4%). Organ failures were more frequent in ACLF-3, except renal failure (greater in ACLF-1). Transplant-free survival at 180 days was 73.7% in patients without ACLF and 40% in ACLF (p<0.001). In a Cox regression adjusted by age and sex, transplant-free survival was significantly lower in ACLF-3 compared to patients without ACLF (HR 3.7, 95%CI: 2.3-5.7;p<0.001). Conclusions: ACLF is an entity of younger patients, with lower global and transplantation-free survival at 180 days and multiple organ failure compared to decompensated cirrhotics without ACLF.