The prognostic determinant in acute on chronic liver failure: a multicentre prospective cohort study

Abstract

Background: Acute on Chronic Liver Failure (ACLF) is an evolving concept. There is scarce data on prognostication of ACLF cases mentioned in the literature. The present study was undertaken to find out the prognostic determinant in ACLF patients. Method: ACLF concept was defined as per Asian Pacific Association for the Study of Liver (APASL) consensus criteria 2014. Consecutive cases attending different centers in India and other Asian countries satisfying the above criteria were included and prospectively evaluated for three months Result: Out of total 2000 patients with ACLF (mean age: 36 years; M/F-1669:331), 30% and 44.25% patients died within 1 and 3 months respectively. Most of the deaths occurred in cases having acidosis [Adjusted odds ratio (AOR):30.04]; fever (AOR: 3.08); multiple organ failure (AOR: 1.95); cerebral failure (AOR: 1.44); renal failure (AOR: 1.4); prolonged ICU stay (AOR: 1.36); higher serum lactate (AOR: 1.17); higher serum bilirubin(AOR: 1.06); higher INR(PT) with AOR: 1.02; higher leukocyte count (AOR: 1.01); higher heart rate (AOR: 1.01). APASL ACLF Research Consortium (AARC score with AOR: 1.29) correlated better with early mortality compared to other prognostic scorings [SOFA (AOR: 1.11); MELD (AOR: 1.05); APACHAE (AOR: 1.04); CTP (AOR: 1.01); Glasgow coma scale (AOR: 0.95); CLIF SOFA (AOR: 0.92)]. Conclusion: ACLF patients in Asian countries had high early (3 months) mortality with majority of death occurring in cases having acidosis, fever, and multiple organ failure. AARC scoring is the single most important prognostic determinant in prediction of early mortality in ACLF cases.