title: Clinical profile, natural history, and predictors of mortality in patients with acute-on-chronic liver failure (ACLF).
abstract: BACKGROUND
  Acute-on-chronic liver failure (ACLF) is an increasingly recognized entity encompassing an acute deterioration of liver function in patients with cirrhosis, either secondary to superimposed liver injury or due to extrahepatic precipitating factors such as infection culminating in the end-organ dysfunction. Its main features are reversibility and high short-term mortality due to multiorgan failure (MOF). We aimed to analyze the clinical, laboratory, and etiological predictors of mortality and outcome in patients with ACLF.
  
  
  METHODS
  We evaluated 1215 patients with chronic liver disease; 90 patients met the criteria for ACLF.
  
  
  RESULTS
  The most common cause of underlying chronic liver disease was alcohol, and the most common acute insult (AI) in those patients was superadded alcoholic hepatitis. In all, 50% of all patients died within 30 days (71.1 % within the first 14 days after admission). MOF was the cause of death in 70 % of cases. On multivariate analysis, high serum potassium, serum creatinine higher than 90 µmol/L, and C-reactive protein > 30 mg/L were found to be independent baseline predictors of mortality. APACHE II (Acute Physiology and Chronic Health Evaluation II) score was the best predictor of short-term mortality (area under the curve (AUC), 0.878). MOF was a valuable predictor of mortality (AUC, 0.923); 33 of 35 patients who had MOF at admission died. Presence of positive systemic inflammatory response syndrome criteria at admission was also correlated with in-hospital mortality (AUC, 0.742).
  
  
  CONCLUSIONS
  ACLF is a serious condition with high short-term mortality. Because ACLF is reversible, it is necessary to identify at-risk patients as soon as possible to treat acute events in a timely manner.
authors.affiliation: Department of Gastroenterology, Division of Internal Medicine, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia, ivana.mikolasevic@gmail.com.
authors.forename: Ivana
authors.initials: I
authors.lastname: Mikolasevic
authors.forename: Sandra
authors.initials: S
authors.lastname: Milic
authors.forename: Mladen
authors.initials: M
authors.lastname: Radic
authors.forename: Lidija
authors.initials: L
authors.lastname: Orlic
authors.forename: Zeljka
authors.initials: Z
authors.lastname: Bagic
authors.forename: Davor
authors.initials: D
authors.lastname: Stimac
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000097:blood / Q000175:diagnosis* / Q000401:mortality*; D001317:Austria / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D015897:Comorbidity; D003404:Creatinine / Q000097:blood; D017523:Croatia / Q000453:epidemiology; D018450:Disease Progression; D005260:Female; D006519:Hepatitis, Alcoholic / Q000401:mortality*; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008487:Medical History Taking / Q000706:statistics & numerical data; D008875:Middle Aged; D011188:Potassium / Q000097:blood; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D016019:Survival Analysis
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D003404:Creatinine; D011188:Potassium
references.citation: J Hepatol. 2010 Sep;53(3):397-417
references.pmid: 20633946
references.citation: Hepatol Int. 2009 Dec;3(4):571-81
references.pmid: 19680733
references.citation: Hepatology. 2007 Sep;46(3):922-38
references.pmid: 17879356
references.citation: World J Gastroenterol. 2011 Aug 7;17(29):3448-52
references.pmid: 21876637
references.citation: Crit Care. 2011;15(5):233
references.pmid: 22104633
references.citation: J Hepatol. 2012 Dec;57(6):1336-48
references.pmid: 22750750
references.citation: Lijec Vjesn. 2013 Nov-Dec;135(11-12):322-5
references.pmid: 24490333
references.citation: J Gastroenterol Hepatol. 2006 Oct;21(10):1519-24
references.pmid: 16928211
references.citation: Gastroenterology. 2013 Jun;144(7):1337-9
references.pmid: 23623966
references.citation: Gastroenterology. 2013 Jun;144(7):1426-37, 1437.e1-9
references.pmid: 23474284
references.citation: Korean J Radiol. 2009 Sep-Oct;10(5):481-9
references.pmid: 19721833
references.citation: Hepatol Int. 2011 Jun;5(2):693-7
references.pmid: 21484110
references.citation: Clin Liver Dis. 2009 Feb;13(1):63-6
references.pmid: 19150310
references.citation: Curr Gastroenterol Rep. 2012 Feb;14(1):63-6
references.pmid: 22086408
references.citation: Hepatology. 2001 Aug;34(2):255-61
references.pmid: 11481609
references.citation: Eur J Gastroenterol Hepatol. 2001 Apr;13(4):313-6
references.pmid: 11338056
references.citation: BMC Gastroenterol. 2013 Apr 03;13:58
references.pmid: 23551795
references.citation: Eur J Gastroenterol Hepatol. 2010 Feb;22(2):213-20
references.pmid: 19773666
references.citation: Hepatol Int. 2009 Mar;3(1):269-82
references.pmid: 19669378
references.citation: Curr Opin Crit Care. 2011 Apr;17(2):165-9
references.pmid: 21326095
references.citation: Curr Opin Crit Care. 2011 Apr;17(2):184-9
references.pmid: 21311322
references.citation: QJM. 2010 Jan;103(1):9-16
references.pmid: 19903725
references.citation: Rev Esp Enferm Dig. 2011 Apr;103(4):177-83
references.pmid: 21526870
references.citation: Expert Rev Gastroenterol Hepatol. 2011 Aug;5(4):523-37; quiz 537
references.pmid: 21780899
references.citation: Dig Liver Dis. 2012 Feb;44(2):166-71
references.pmid: 21978580
references.citation: PLoS One. 2012;7(12):e50952
references.pmid: 23272081