title: Characteristics and Discrepancies in Acute-on-Chronic Liver Failure: Need for a Unified Definition.
abstract: To investigate the prevalence, mortalities, and patient characteristics of Acute-on-chronic liver failure (ACLF) according to the AARC (Asian Pacific Association for the Study of the Liver ACLF Research Consortium) and European Association for the Study of the Liver CLIF-C (Chronic Liver Failure Consortium) definitions.
  
  
  
  We collected retrospective data for 1470 hospitalized patients with chronic liver disease (CLD) and acute deterioration between January 2013 and December 2013 from 21 university hospitals in Korea.
  
  
  
  Of the patients assessed, the prevalence of ACLF based on the AARC and CLIF-C definitions was 9.5% and 18.6%, respectively. The 28-day and 90-day mortality rates were higher in patients with ACLF than in those without ACLF. Patients who only met the CLIF-C definition had significantly lower 28-day and 90-day survival rates than those who only met the AARC definition (68.0% vs. 93.9%, P<0.001; 55.1% vs. 92.4%, P<0.001). Among the patients who had non-cirrhotic CLD, the 90-day mortality of the patients with ACLF was higher than of those without ACLF, although not significant (33.3% vs. 6.0%, P = 0.192). Patients with previous acute decompensation (AD) within 1- year had a lower 90-day survival rate than those with AD more than 1 year prior or without previous AD (81.0% vs. 91.9% or 89.4%, respectively, all P<0.001). Patients who had extra-hepatic organ failure without liver failure had a similar 90-day survival rate to those who had liver failure as a prerequisite (57.0% vs. 60.6%, P = 0.391).
  
  
  
  The two ACLF definitions result in differences in mortality and patient characteristics among ACLF patients. We suggest that non-cirrhotic CLD, previous AD within 1 year, and extra-hepatic organ failure should be included in the ACLF diagnostic criteria. In addition, further studies are necessary to develop a universal definition of ACLF.
authors.affiliation: Institute of Medical Science, Hanyang University, Seoul, Republic of Korea.
authors.forename: Tae Yeob
authors.initials: TY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Do Seon
authors.initials: DS
authors.lastname: Song
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Hee Yeon
authors.initials: HY
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Samsung Medical Center, Seoul, Republic of Korea.
authors.forename: Dong Hyun
authors.initials: DH
authors.lastname: Sinn
authors.affiliation: Department of Internal Medicine, Inje University Sanggye Paik Hospital, Seoul, Republic of Korea.
authors.forename: Eileen L
authors.initials: EL
authors.lastname: Yoon
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Chang Wook
authors.initials: CW
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
authors.forename: Young Kul
authors.initials: YK
authors.lastname: Jung
authors.affiliation: Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.
authors.forename: Ki Tae
authors.initials: KT
authors.lastname: Suk
authors.affiliation: Department of Internal Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea.
authors.forename: Sang Soo
authors.initials: SS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Catholic University of Daegu School of Medicine, Daegu, Republic of Korea.
authors.forename: Chang Hyeong
authors.initials: CH
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Ewha Womans University School of Medicine, Seoul, Republic of Korea.
authors.forename: Tae Hun
authors.initials: TH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jeong Han
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Konkuk University School of Medicine, Seoul, Republic of Korea.
authors.forename: Won Hyeok
authors.initials: WH
authors.lastname: Choe
authors.affiliation: Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Republic of Korea.
authors.forename: Hyung Joon
authors.initials: HJ
authors.lastname: Yim
authors.affiliation: Department of Internal Medicine, Hallym University Sacred Heart Hospital, Anyang, Republic of Korea.
authors.forename: Sung Eun
authors.initials: SE
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Soon Koo
authors.initials: SK
authors.lastname: Baik
authors.affiliation: Department of Internal Medicine, Chungnam National University, School of Medicine, Daejeon, Republic of Korea.
authors.forename: Byung Seok
authors.initials: BS
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Soonchunhyang University College of Medicine, Seoul, Republic of Korea.
authors.forename: Jae Young
authors.initials: JY
authors.lastname: Jang
authors.affiliation: Department of Internal Medicine, Dongguk University Gyeongju Hospital, Gyeongju, Republic of Korea.
authors.forename: Jeong
authors.initials: J
authors.lastname: Suh
authors.affiliation: Department of Internal Medicine, Hallym University Kangdong Sacred Heart Hospital, Seoul, Republic of Korea.
authors.forename: Hyoung Su
authors.initials: HS
authors.lastname: Kim
authors.affiliation: Department of Internal medicine, National Medical Center, Seoul, Republic of Korea.
authors.forename: Seong Woo
authors.initials: SW
authors.lastname: Nam
authors.affiliation: Department of Internal medicine, National Medical Center, Seoul, Republic of Korea.
authors.forename: Hyeok Choon
authors.initials: HC
authors.lastname: Kwon
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
authors.forename: Young Seok
authors.initials: YS
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Republic of Korea.
authors.forename: Sang Gyune
authors.initials: SG
authors.lastname: Kim
authors.affiliation: Department of Internal medicine, College of Medicine and Medical Research Institute, Chungbuk National University, Cheongju, Republic of Korea.
authors.forename: Hee Bok
authors.initials: HB
authors.lastname: Chae
authors.affiliation: Department of Internal Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea.
authors.forename: Jin Mo
authors.initials: JM
authors.lastname: Yang
authors.affiliation: Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea.
authors.forename: Joo Hyun
authors.initials: JH
authors.lastname: Sohn
authors.affiliation: Department of Internal Medicine, Yeungnam University College of Medicine, Daegu, Republic of Korea.
authors.forename: Heon Ju
authors.initials: HJ
authors.lastname: Lee
authors.affiliation: Department of Internal Medicine, Inje University Haeundae Paik-Hospital, Inje University College of Medicine, Busan, Republic of Korea.
authors.forename: Seung Ha
authors.initials: SH
authors.lastname: Park
authors.affiliation: Department of Internal Medicine, Kosin University College of Medicine, Busan, Republic of Korea.
authors.forename: Byung Hoon
authors.initials: BH
authors.lastname: Han
authors.affiliation: Institute of Lifestyle Medicine, Yonsei University Wonju College of Medicine, Wonju, Republic of Korea.
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Choi
authors.affiliation: Department of Internal Medicine, University Hospitals Case Medical Center, Cleveland, Ohio, United States of America.
authors.forename: Chang H
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Internal Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.
authors.forename: Dong Joon
authors.initials: DJ
authors.lastname: Kim
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis* / Q000401:mortality*; D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D006801:Humans; D008875:Middle Aged; D015995:Prevalence; D015996:Survival Rate