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Abstracts of the 2021 Annual meeting of the ALEH (Asociación Latinoamericana para el Estudio del Hígado)
More infoAcute-on-chronic liver failure (ACLF) is a serious clinical entity, with no previous reports in Chile.
AimTo characterize patients with ACLF in a Chilean University Hospital, identifying triggers, organ failure and survival at 30, 90, 180 days, compared to patients with decompensated cirrhosis without ACLF.
MethodsRetrospective cohort study of decompensated cirrhotic patients hospitalized in a chilean University Hospital between 2017-2019.
Results334 patients were included, 73 (22%) presented ACLF (33% ACLF-1, 30% ACLF-2, 37% ACLF-3); 16.4% underwent liver transplantation. Patients with ACLF were younger, and had higher MELD-Na and APACHE II on admission. The most common triggers in both groups were infections (42.4%), gastrointestinal bleeding (23.2%) and alcohol intake (31.3%). The main organ failures were kidney (60.2%) and brain (49.3%). All organ failures were more frequent in ACLF-3, except renal failure (greater in ACLF-1). Survival at 180 days was 74% in patients without ACLF and 58.3% in ACLF (p=0.004). Mortality was significantly higher in ACLF-2 and ACLF-3, when compared with patients without ACLF (HR 2.3 and 2.99, respectively; p<0.05). Transplant-free survival in cirrhotics without ACLF was 72.5% versus 43.1% with ACLF (p<0.001). The risk of mortality or transplantation was higher in ACLF-2 and ACLF-3, in contrast to patients without ACLF (HR 2.19 and 4.61, respectively; p <0.05).
ConclusionsACLF 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.