Profile of ACLF cases in Asia: A multicentre study

Abstract

Background: Acute on Chronic Liver Failure (ACLF) is an emerging entity. There is scarce data on profile of ACLF cases in the literature. The present study was undertaken to study the profile of ACLF cases in Asia. 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: 45.61 ± 12.87 years), male outnumbered the female (Male: Female-5:1). Most common underlying chronic liver disease (CLD) and acute insult were alcoholic liver disease (46.8%) and drinking of alcohol (43.6%) respectively. Ascites and hepatic encephalopathy were present in 74.2% and 35.55% cases respectively. Mean serum bilirubin was 18.85 ± 10.08 mg/dl. 44.25% patients died within 3 months (early mortality). Early mortality was most common in alcoholics (49.15%). The prognostic scorings at base line were CLIF SOFA: 11.7 ± 2.91; APASL ACLF Research Consortium (AARC) SCORE: 9.75 ± 2.11; APACHAE: 15.63 ± 6.68; SOFA: 8.71 ± 3.11; CTP: 11.7 ± 1.59; MELD: 27.92 ± 7.49; MELD Na: 30.95 ± 7.15. All these prognostic scorings were significantly higher in died patients compared to survived patients (p: 0.0001). Multivariate logistic regression analysis showed that AARC scoring is the single most important predictor for early mortality. Conclusion: ACLF patients in Asian countries had high early mortality with majority of death occurring in alcoholics. AARC scoring is the single most important prognostic determinant in prediction of early mortality in ACLF cases.