title: Prevalence and risk factors of acute-on-chronic liver failure in a single center from Argentina.
abstract: OBJECTIVE
  To study the prevalence, characteristics, risk factors and mortality at 28 d of acute-on-chronic liver failure (ACLF).
  
  
  METHODS
  A total of 100 cirrhotic patients admitted to our hospital for more than one day were included during the period between June 2013 and December 2015. We used the European Association for the Study of the Liver-Chronic Liver Failure-Consortium diagnostic criteria for ACLF, considering it as the acute decompensation of cirrhosis associated with the presence of one or more organ failure. For the diagnosis of organic failure the Chronic Liver Failure-Sequential Organ Failure Assessment score was used. Our population was divided into patients with and without ACLF. Clinical characteristics, presence of precipitating events, potential risk factors for developing ACLF and causes of mortality were analyzed. Mortality at 28 d was evaluated.
  
  
  RESULTS
  Twenty-nine patients (29%) developed ACLF criteria. Alcoholism, detected in 58 patients (58%), was the major etiological agent of cirrhosis. Bacterial infections were recognized as a precipitating event in 41.3% of cases and gastrointestinal bleeding in 27.5%. No precipitating event was identifiable in 27.5% of patients with ACLF. Comparing patients with and without ACLF, statistically significant risk factors were: Child Pugh score 10.2 ± 2.1vs8.4 ± 1.6 (P˂ 0.0001), MELD score 20.7 ± 8.5vs12.3 ± 4 (P˂ 0.0001), presence of ascites 27 (93%)vs43 (60.5%) (P= 0.001), leukocytosis 15300 ± 8033 per cubic millimetervs10770 ± 5601 per cubic millimeter (P˂ 0.0001), and high plasma levels of C reactive protein values 50.9 ± ​​46.4 mg/Lvs28.6 ± 23.4 mg/L (P˂ 0.0019). Mortality rate was 62% (18 patients)vs5.6% (4 patients), respectively (P< 0.0001).
  
  
  CONCLUSIONS
  We observed that the ACLF is a frequent entity in this group of patients and has a significantly higher mortality rate.
authors.affiliation: Cristian Dominguez, Eugenia Romero, Jorgelina Graciano, Jose Luis Fernandez, Luis Viola, Division of Gastroenterology, Sanatorio Guemes, Buenos Aires C1425EUG, Argentina.
authors.forename: Cristian
authors.initials: C
authors.lastname: Dominguez
authors.affiliation: Cristian Dominguez, Eugenia Romero, Jorgelina Graciano, Jose Luis Fernandez, Luis Viola, Division of Gastroenterology, Sanatorio Guemes, Buenos Aires C1425EUG, Argentina.
authors.forename: Eugenia
authors.initials: E
authors.lastname: Romero
authors.affiliation: Cristian Dominguez, Eugenia Romero, Jorgelina Graciano, Jose Luis Fernandez, Luis Viola, Division of Gastroenterology, Sanatorio Guemes, Buenos Aires C1425EUG, Argentina.
authors.forename: Jorgelina
authors.initials: J
authors.lastname: Graciano
authors.affiliation: Cristian Dominguez, Eugenia Romero, Jorgelina Graciano, Jose Luis Fernandez, Luis Viola, Division of Gastroenterology, Sanatorio Guemes, Buenos Aires C1425EUG, Argentina.
authors.forename: Jose Luis
authors.initials: JL
authors.lastname: Fernandez
authors.affiliation: Cristian Dominguez, Eugenia Romero, Jorgelina Graciano, Jose Luis Fernandez, Luis Viola, Division of Gastroenterology, Sanatorio Guemes, Buenos Aires C1425EUG, Argentina.
authors.forename: Luis
authors.initials: L
authors.lastname: Viola
keywords: Acute liver decompensation; Acute-on-chronic liver failure; Ascites; Cirrhosis; Mortality