title: Clinical profile and predictors of mortality in patients of acute-on-chronic liver failure.
abstract: BACKGROUND
  Acute-on-chronic liver failure (ACLF) is characterised by acute hepatic insult manifesting as jaundice and coagulopathy, complicated within 4 weeks by ascites and/or encephalopathy in patients with previously diagnosed or undiagnosed chronic liver disease. We studied the clinical, biochemical and etiological profiles of ACLF patients investigating variables which could predict mortality.
  
  
  METHODS
  Consecutive ACLF patients were enrolled and given standard intensive care management. They were monitored for predictors of 90-day mortality.
  
  
  RESULTS
  91 patients were included; besides jaundice (median bilirubin 23.1mg/dL) and coagulopathy, acute onset ascites with or without encephalopathy was the presenting symptom in 92%. In all patients a first diagnosis of chronic liver disease was made, mainly due to hepatitis B (37%) or alcohol (34%). Reactivation of chronic hepatitis B and alcoholic hepatitis were the common acute insults. The 90-day mortality was 63%. On multivariate analysis, hepatic encephalopathy, low serum sodium, and high INR were found to be independent baseline predictors of mortality. Amongst all severity scores studied, MELD, SOFA and APACHE-II scores had AUROCs of >0.8 which was significantly higher than that of Child-Turcotte-Pugh.
  
  
  CONCLUSIONS
  ACLF has very high mortality. Hepatic encephalopathy, low serum sodium and high INR predict poor outcome. Mortality can also be predicted by baseline MELD, SOFA or APACHE-II scores.
authors: Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
authors: Hitendra
authors: H
authors: Garg
authors: Ashish
authors: A
authors: Kumar
authors: Vishal
authors: V
authors: Garg
authors: Praveen
authors: P
authors: Sharma
authors: Barjesh Chander
authors: BC
authors: Sharma
authors: Shiv Kumar
authors: SK
authors: Sarin
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D058625:End Stage Liver Disease / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007194:India / Q000453:epidemiology; D007565:Jaundice / Q000175:diagnosis / Q000453:epidemiology* / Q000209:etiology; D017114:Liver Failure, Acute / Q000150:complications / Q000175:diagnosis / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D055815:Young Adult