Epidemiology and demographic aspects in patients with acute on chronic liver failure in a third-level care hospital in Mexico.

Introduction and Objectives

Patients presenting with acute on chronic liver failure (ACLF) is a syndrome characterized by acute decompensation of cirrhosis associated with failures of different organs as well as leading to high mortality in the short term, being its demographic and epidemiological characteristics important points to evaluate predictors of poor prognosis in this group of patients. This study aimed to characterize the demographic aspects of patients with acute on chronic in the Mexican population.

Materials and Patients

A retrospective, observational, descriptive and unicentric study was carried out, which included patients with a confirmed diagnosis of ACLF who had been hospitalized during the period from 2017 to 2022 in the gastroenterology service of Centro Médico Nacional Siglo XXI "Bernardo Sepulveda," IMSS.

Results

186 patients were included, 95 women (51%) and 91 men (49%) being more prevalent in the range between 56-65 years 59 patients (32%). The most frequent etiology of cirrhosis was NAFLD (esteatohepatitisc not alcoholic) in 54 (29%) and ethylism in 42 (23%). A MELD of 31-35 predominated in 50 patients (27%) and a Child Pugh C in 163 patients (87%). The antecedent of at least one previous decompensation was found in 161 (85%), the most common being ascites in 141 (76%) followed by hepatic encephalopathy in 95 (51%). 25 patients (13%) had no previous decompensation. The infection was identified as precipitating in 111 (60%) and without precipitating factor identified in 21 (11%). The most frequently identified infectious focus was abdominal in 60 (36%) and urinary in 40 (24%). The most frequent isolated agent was Escherichia coli in 22 (12%). Hepatorenal syndrome was found in 12 patients (6%). At admission, grade I ACLF occurred in 37 (20%), grade II 72 (39%), grade III 77 (49%) with a predominant CLIF C between 51-60 points in 99 patients (53%) requiring an average of 8 days of hospitalization.

Conclusions

We found that the ACLF does not present gender predilection as being more frequent between 56-65 years. The main etiology of cirrhosis was NAFLD, the majority being found in Child-Pugh C. Most have a history of at least one decompensation, the most frequent being ascites. 13% debuted with ACLF as the first decompensation. The most common precipitant was infectious, with the abdominal focus manifested as PBE as the main one. The most common agent was Escherichia coli. At admission, ACLF grade III was the most common.

Ethical statement

The protocol was registered and approved by the Ethics Committee. The identity of the patients is protected. Consentment was obtained.

Declaration of interests

None

Funding

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.

Table 1. Baseline characteristics of patients with ACLF

CBP: Primary biliary cholangitis, AIH. Autoimmune hepatitis. CEP: Primary sclerosing cholangitis. NAFLD: Steatonepatitis not alcoholic. HCV: hepatitis C virus. HBV: hepatitis B virus. CLIF C ACLF: scale for mortality of acute on chronic liver failure. MELD: Model for end-stage liver disease