O-7 PREVALENCE, CHARACTERIZATION AND SURVIVAL OF ACUTE-ON-CHRONIC LIVER FAILURE IN A CHILEAN UNIVERSITY HOSPITAL

Background

Acute-on-chronic liver failure (ACLF) is a serious clinical entity, with no previous reports in Chile.

Aim

To 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.

Methods

Retrospective cohort study of decompensated cirrhotic patients hospitalized in a chilean University Hospital between 2017-2019.

Results

334 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).

Conclusions

ACLF 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.