title: Population-representative Incidence of Acute-On-Chronic Liver Failure: A Prospective Cross-Sectional Study.
abstract: Acute-on-chronic liver failure (ACLF) is a major cause of hepatic death in the world, but no population-based studies have evaluated the incidence of ACLF. This study was conducted to determine the incidence and short-term outcomes of ACLF in a region of Eastern China.
  
  
  
  In this prospective cross-sectional study, we collected data from public hospitals in Nantong city between January 1, 2005, and December 31, 2014. All hospitals with admission potential for ACLF patients were included. The primary outcome was ACLF defined as severe jaundice and coagulopathy with underlying chronic liver disease, according to diagnostic and laboratory criteria suggested by Chinese Society for Hepatology (CSH).
  
  
  
  During the 10-year period, a consecutive sample of 1934 ACLF patients was included in this study. The overall ACLF incidence rate over the 10-year period was 2.53 (95% confidence interval, 2.16-2.91) per 100,000 population per year, decreasing from 3.35 in 2005 to 2.06 in 2014. Chronic hepatitis B virus (HBV) infection was the leading cause of chronic liver disease and HBV reactivation was the most common cause of acute hepatic event. The 28-day mortality for the ACLF patients had a clear decline during the study period, form 50.39% in 2005 to 35.44% in 2014.
  
  
  
  In the Eastern China population, the incidence of ACLF is decreasing and the prognosis improving. Short-term mortality was associated with the presence of cirrhosis and growing age. While ACLF remains a life-threatening disorder, our findings suggest that nationwide and long-term cohorts should be conducted for the natural history of ACLF.
authors.affiliation: *Center for Liver Diseases, Nantong Third People's Hospital †Department of Epidemiology and Medical Statistics, School of Public Health **Department of Pathology, Medical School, Nantong University ‡Department of Infectious Diseases, Qidong Third People's Hospital §Department of Infectious Diseases, Haimen People's Hospital ∥Department of Infectious Diseases, Rugao People's Hospital ¶Department of Infectious Diseases, Rudong People's Hospital #Department of Infectious Diseases, Hai'an People's Hospital, Nantong, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Qin
authors.forename: Jian-Guo
authors.initials: JG
authors.lastname: Shao
authors.forename: Yong-Chang
authors.initials: YC
authors.lastname: Zhu
authors.forename: Ai-Dong
authors.initials: AD
authors.lastname: Xu
authors.forename: Jian-Hua
authors.initials: JH
authors.lastname: Yao
authors.forename: Xu-Lin
authors.initials: XL
authors.lastname: Wang
authors.forename: Yin-Kun
authors.initials: YK
authors.lastname: Qian
authors.forename: Hua-Yu
authors.initials: HY
authors.lastname: Wang
authors.forename: Yi
authors.initials: Y
authors.lastname: Shen
authors.forename: Peng
authors.initials: P
authors.lastname: Lu
authors.forename: Lu-Jun
authors.initials: LJ
authors.lastname: Wang
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000453:epidemiology* / Q000209:etiology / Q000401:mortality; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002681:China / Q000453:epidemiology; D003430:Cross-Sectional Studies; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008103:Liver Cirrhosis / Q000453:epidemiology* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D055815:Young Adult