Clinical Outcome and Prognosis of Acute-on-Chronic Liver Failure: Experience from a Tertiary Care Center
Sirimongkolkasem J, MD1,2, Teerasarntipan T, MD1,2, Wongkarnjana A, MD1,2, Thanapirom K, MD1,2, Chaiteerakij R, MD, PhD1,2, Phathong C, MA1, Komolmit P, MD1,2, Tangkijvanich P, MD, PhD3, Treeprasertsuk S, MD, PhD1,2
Affiliation : 1 Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand 2 Thai Red Cross Society, Bangkok, Thailand 3 Liver Research Unit, Department of Biochemistry, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
Objective : The Acute on Chronic Liver failure (ACLF) diagnostic criteria and prognostic score have been well established and the
major cause for cirrhosis is chronic alcoholic liver disease (CANONIC study). However, this criteria has not yet been studied in Asia,
where chronic hepatitis infection is more prevalent. We aimed to determine the outcome of Thai patients with ACLF and validate
the CLIF-C organ failure (CLIF-C OF) score for ACLF diagnosis and CLIF-ACLF score for predicting prognosis.
Materials and Methods : We prospectively enrolled cirrhotic patients hospitalized with acute decompensation (AD). Primary end
point was 3-month mortality. Factors associated with mortality were determined using logistic regression analysis.
Results : We enrolled 95 cirrhotic patients with mean age of 56 years. The most common etiology of cirrhosis was chronic viral
hepatitis (48.5%) and alcoholism (44.2%). Forty patients (42%) were diagnosed with ACLF. The 3-month mortality rate was well
correlated with the 3 ACLF subclasses, i.e. 45.5%, 53.6% and 80%, respectively. From the multivariate analysis, CLIF-ACLF score
was the only independent predictor for the 3-month mortality in the ACLF group (adjusted OR 1.114, p = 0.008). Additionally, CLIF-
ACLF score had the AUROC of 0.78 which was significantly higher than the other 4 scores studied (p<0.05).
Conclusion : ACLF is a distinct condition associated with high mortality and organ failures. CLIF-C organ failure (CLIF-C OFs) and
CLIF-ACLF scores can be used to diagnose, classify and prognose ACLF in the Thai population.
Keywords : Acute-on-chronic liver failure, Outcome, Prognosis
