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Annals of Hepatology
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Inicio Annals of Hepatology OP-5 ACUTE-ON-CHRONIC LIVER FAILURE (ACLF) CRITERIA IN ALCOHOL-ASSOCIATED HEPATI...
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Vol. 29. Issue S3.
Abstracts of the 2024 Annual Meeting of the ALEH
(December 2024)
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Vol. 29. Issue S3.
Abstracts of the 2024 Annual Meeting of the ALEH
(December 2024)
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OP-5 ACUTE-ON-CHRONIC LIVER FAILURE (ACLF) CRITERIA IN ALCOHOL-ASSOCIATED HEPATITIS: IMPLICATIONS FOR LIVER TRANSPLANTATION
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LUIS ANTONIO DÍAZ PIGA1, Paula Huerta2, Renata Farias3, Bastian Alcayaga4, Francisco Idalsoaga3, Gustavo Ayares3, Jorge Arnold3, María Ayala-Valverde5, Diego Perez6, Jaime Gomez6, Rodrigo Escarate6, Eduardo Fuentes-López7, Katherine Maldonado8, Juan Pablo Roblero9, Daniela Simian9, Blanca Norero10, Raul Lazarte9, José Antonio Velarde11, Jacqueline Córdova12, Fátima Higuera-de-la-Tijera13..., Alfredo Servin-Caamaño13, Jesús Varela14, Scherezada Mejía Loza15, Rita Silva16, Cristina Melo Rocha17, Roberta C. Araujo18, Gustavo Henrique Pereira19, Claudia Alves Couto20, Fernando Bessone21, Mario Tanno21, Gustavo Romero22, Manuel Mendizabal23, Sebastián Marciano24, Gonzalo Gomez Perdiguero24, Melisa Dirchwolf25, Pedro Montes26, Patricia Guerra Salazar27, Geraldine Ramos27, Susana Castro Sánchez28, Juan Carlos Restrepo28, Enrique Carrera29, Mayur Brahmania30, Ashwani K. Singal31, Winston Dunn32, Ramon Bataller33, Vijay Shah34, Patrick S. Kamath34, Marco Arrese3, Juan Pablo Arab35Ver más
1 MASLD Research Center, University of California San Diego, San Diego, California, Estados Unidos (EEUU)
2 Programa de Medicina Interna, Facultad de Medicina Clínica Alemana - Universidad del Desarrollo, Santiago, Chile
3 Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
4 Escuela de Medicina, Pontificia Universidad Católica de Chile, Chile
5 Santiago, Chile
6 Servicio Medicina Interna, Hospital El Pino, Santiago, Chile
7 Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
8 Unidad de Gastroenterología, Hospital Roosevelt, Ciudad de Guatemala, Guatemala
9 Sección Gastroenterología, Hospital Clínico Universidad de Chile, Escuela de Medicina Universidad de Chile, Santiago, Chile
10 Hospital Sótero del Río, Santiago, Chile
11 Hospital Civil Guadalajara, Guadalajara, México
12 Hospital General Manuel Gea González, Mexico City, México
13 Servicio de Gastroenterología, Hospital General de México “Dr. Eduardo Liceaga", Mexico City, México
14 Hospital Dublán, Chihuahua, México
15 Hospital Juárez de México, Mexico City, México
16 Unidade de Transplante de Figado e do Hospital de Base da Faculdade de Medicina de São Jose do Rio Preto, Sao Paulo, Brasil
17 Fundação Hospital Adriano Jorge, Amazonas, Brasil
18 Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto, Ribeirão Preto, Brasil
19 Hospital Federal de Bonsucesso, Rio de Janeiro, Brasil
20 Hospital das Clinicas da Universidade Federal de Minas Gerais, Belo Horizonte, Brasil
21 Hospital Provincial del Centenario, Santa Fe, Argentina
22 Hospital de Gastroenterología " Dr. Carlos Bonorino Udaondo", Buenos Aires, Argentina
23 Hospital Universitario Austral, Buenos Aires, Argentina
24 Hospital Italiano Buenos Aires, Buenos Aires, Argentina
25 Unidad de Trasplante Hepático, Servicio de Hepatología, Hospital Privado de Rosario, Rosario, Argentina
26 Hospital Nacional Daniel Alcides Carrión - Callao, Bellavista, Perú
27 Instituto Gastroenterológico Boliviano- Japonés, Cochabamba, Bolivia
28 Hospital Pablo Tobon Uribe. Universidad de Antioquia, Medellin, Colombia
29 Hospital Especialidades Eugenio Espejo, Quito, Ecuador
30 Univeristy of Calgary, Cumming School of Medicine, Calgary, Alberta, Canadá
31 Division of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Louisville School of Medicine, Louisville, Kentucky, Estados Unidos (EEUU)
32 University of Kansas Medical Center, Kansas, Estados Unidos (EEUU)
33 Liver Unit, Hospital Clinic, Barcelona, España
34 Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota, Estados Unidos (EEUU)
35 Division of Gastroenterology, Hepatology, and Nutrition, Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, Virginia, Estados Unidos (EEUU)
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Vol. 29. Issue S3

Abstracts of the 2024 Annual Meeting of the ALEH

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Introduction and Objectives

Background: Severe alcohol-associated hepatitis (AH) is considered a common precipitant of acute-on-chronic liver failure (ACLF). This study aims to characterize the association between AH and ACLF, focusing on mortality across different ACLF grades.

Patients / Materials and Methods

Multicenter prospective cohort study. We included patients admitted with severe AH between 2015–2022. The main outcome was mortality by ACLF grade during admission. The analysis included survival analysis using Cox regression. We adjusted multivariable models based on the main predictors of mortality observed in prior studies.

Results and Discussion

We prospectively included 646 patients from 24 centers and 8 countries. Age 49.9±11.7 years, 85.1% of men and 64.4% had a previous diagnosis of cirrhosis. Median MELD at admission was 25 [20-31] points, 46.5% of patients were treated with corticosteroids, and only 2.2% underwent liver transplantation (LT). Around 67.4% of patients fulfilled ACLF criteria: 10.1% grade 1, 19.2% grade 2, and 38.1% grade 3. The most frequent organ dysfunctions were 76.2% liver, 40.8% brain, 43.2% coagulation, 29.6% renal, 29.4% circulatory, and 18.9% lung failure. Survival at 180 days was 77.8% (95%CI: 72.1-82.6%) in those without ACLF grade 3 and 28.0% (95%CI: 20.5–36.0%) in those with ACLF grade 3 (p<0.001). In the multivariable model adjusted by age, body mass index, and MELD score, individuals with ACLF grade 3 had lower survival than those without ACLF (HR 2.67, 95%CI: 1.50–4.76; p=0.001). However, those with ACLF grade 1 (HR 1.50, 95%CI: 0.76–2.96; p=0.243) and grade 2 (HR 0.70, 95%CI: 0.31–1.56; p=0.380) were not associated with a higher mortality than those without ACLF.

Conclusions

Among patients with AH, only ACLF grade 3 is a major determinant of morbimortality. Thus, patients who fulfill ACLF grade 3 should promptly be referred for early LT. The redefinition of ACLF in AH is essential for better quantifying the severity and determining therapeutic goals.

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