title: Acute-on-Chronic Liver Failure (ACLF) in Coastal Eastern India: "A Single-Center Experience".
abstract: OBJECTIVE
  Acute-On-Chronic liver failure (ACLF) is an emerging entity. The present study was undertaken to analyze the clinical profile and natural course of ACLF patients.
  
  
  METHODS
  ACLF was defined as per Asia Pacific Association for the Study of Liver consensus criteria 2009. Patients fulfilling these criteria with some deviations were included and prospectively evaluated for clinical profile, etiologies of acute decompensation (AD) and underlying chronic liver disease, and short-term natural course [3 months].
  
  
  RESULTS
  Out of 123 patients with ACLF (mean age: 45.83 ± 12.05 years; male:female 109:14), 45.53% cases had prior history of AD, and 54.47% presented for the first time as ACLF. Etiologies of cirrhosis were alcohol, cryptogenic, and chronic hepatitis B virus infection in 65.04%, 23.57%, and 11.38% cases, respectively. Recent history of alcohol intake (within 4 weeks) [42.27%] followed by bacterial infections [36.58%] were the common etiologic precipitants for AD. Only 87 (70.73%) out of 123 cases could be followed up for a duration of 3 months; 62 (71.26%) cases died by 3 months. Most deaths occurred in the alcoholics compared to nonalcoholics [(43/53) 81.13% vs. (19/34) 55.88%; P = 0.01]. No significant difference in mortality rate was observed between ACLF cases with history of prior AD compared to newly diagnosed ACLF cases [30/40 (75%) vs. 32/47 (68.09%); P = 0.477]. The prognostic markers [MELD, MELD-Na, CTP] were not significantly different between survivors and nonsurvivors.
  
  
  CONCLUSIONS
  ACLF patients in our population had high short-term mortality rates with majority of deaths in alcoholics. Alcohol intake and bacterial infections were mainly responsible for AD in our study.
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Girish Kumar
authors.initials: GK
authors.lastname: Pati
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Ayaskanta
authors.initials: A
authors.lastname: Singh
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Bijay
authors.initials: B
authors.lastname: Misra
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Debasis
authors.initials: D
authors.lastname: Misra
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Haribhakti Seba
authors.initials: HS
authors.lastname: Das
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Chittaranjan
authors.initials: C
authors.lastname: Panda
authors.affiliation: Department of Gastroenterology, S.C.B. Medical College, Cuttack 753007, India.
authors.forename: Shivaram Prasad
authors.initials: SP
authors.lastname: Singh
keywords: ACLF, acute-on-chronic liver failure; AD, acute decompensation; ALD, alcoholic liver disease; ALT, alanine transaminase; APASL, Asian Pacific Association for the Study of the Liver; CLD, chronic liver disease; CTP, Child-Turcotte-Pugh; EASL-AASLD, European Association for the Study of the Liver-American Association for the Study of Liver Diseases; HBV, hepatitis B virus; HE, hepatic encephalopathy; HEV, hepatitis E virus; HRS, hepatorenal syndrome; INR, International Normalized Ratio; MELD, Model for End-Stage Liver Disease; MELD-Na, Model for End-Stage Liver Disease Sodium; PT, prothrombin time; SD, standard deviation; SIRS, systemic inflammatory response syndrome; ascites; encephalopathy; hepatic decompensation; renal failure; sepsis