title: Predictors of progression into acute-on-chronic liver failure from acute deterioration of pre-existing chronic liver disease.
abstract: OBJECTIVE
  To compare the prognosis between the patients with progression into acute-on-chronic liver failure (ACLF) from acute deterioration of pre-existing chronic liver disease and patients without this progression, and to determine predictors of this disease progression.
  
  
  METHODS
  We retrospectively analyzed clinical data from 285 patients admitted with acute worsening of pre-existing chronic liver disease within 4 weeks characterized by total bilirubin (TBIL) of 51 μM/L or more and prothrombin activity (PTA) of more than 40% but less than 70%, which did not meet the Asia-Pacific Association for the Study of the Liver criteria for ACLF. Patient survival was estimated by Kaplan-Meier analysis and subsequently compared by log-rank test. Independent predictors of disease progression were determined using univariate analysis and multivariate Cox regression analysis.
  
  
  RESULTS
  The 90-day survival rates significantly worsened in patients with progression into ACLF compared with those without this progression. Baseline TBIL, baseline Model for End-Stage Liver Disease (MELD) score, and the maximum changing rates of PTA level and Child-Turcotte-Pugh (CTP) score were independently associated with progression into ACLF in patients with acute deterioration of pre-existing chronic liver disease.
  
  
  CONCLUSIONS
  Patients with acute worsening of pre-existing chronic liver disease characterized by TBIL of 51 μM/L or more and PTA of more than 40% but less than 70% should receive aggressive prediction and prevention of ACLF development. Baseline TBIL, baseline MELD score, and the maximum changing rates of PTA level and CTP score may early predict the progression into ACLF.
authors.affiliation: The Third Central Clinical College of Tianjin Medical University, Tianjin, China.|Department of Hepatology, Tianjin Third Central Hospital, Tianjin, China.
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: The Third Central Clinical College of Tianjin Medical University, Tianjin, China.|Department of Hepatology, Tianjin Third Central Hospital, Tianjin, China.|Tianjin Institute of Hepatobiliary Disease, Tianjin, China.|Tianjin Key Laboratory of Artificial Cells, Tianjin, China.
authors.forename: Tao
authors.initials: T
authors.lastname: Han
authors.affiliation: The Third Central Clinical College of Tianjin Medical University, Tianjin, China.|Department of Hepatology, Tianjin Third Central Hospital, Tianjin, China.|Tianjin Institute of Hepatobiliary Disease, Tianjin, China.|Tianjin Key Laboratory of Artificial Cells, Tianjin, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.affiliation: The Third Central Clinical College of Tianjin Medical University, Tianjin, China.|Department of Hepatology, Tianjin Third Central Hospital, Tianjin, China.
authors.forename: CaiYun
authors.initials: C
authors.lastname: Nie
authors.affiliation: The Third Central Clinical College of Tianjin Medical University, Tianjin, China.|Department of Hepatology, Tianjin Third Central Hospital, Tianjin, China.|Tianjin Institute of Hepatobiliary Disease, Tianjin, China.|Tianjin Key Laboratory of Artificial Cells, Tianjin, China.
authors.forename: Hua
authors.initials: H
authors.lastname: Liu
keywords: acute-on-chronic liver failure; predictors; prognosis; progression