title: Acute-On-Chronic Liver Failure: Causes, Clinical Characteristics and Predictors of Mortality.
abstract: OBJECTIVE
  To determine the causes, characteristics and predictors of mortality in patients with acute-on-chronic liver failure (ACLF).
  
  
  METHODS
  Cross-sectional study.
  
  
  METHODS
  Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, from July 2014 to June 2016.
  
  
  METHODS
  All patients with acute-on-chronic liver disease (ACLD) with ages > 12 were included. Patients with ACLF, as defined by the Asian Pacific Association for the Study of Liver (APASL, 2014) were identified. Predictors of mortality were identified using chi-square or Fisher's exact test.
  
  
  RESULTS
  Included in the study were 72 patients with mean age of 36.71 years, 46 (63.9%) being males. Among them, 61 developed ACLF. Commonest causes of chronic liver disease (CLD) were chronic viral hepatitis (37, 51.4%) and autoimmune hepatitis (14, 19.4%). Commonest causes of acute liver injury (ALI) were acute viral hepatitis (24, 33.3%) and drug induced liver injury (DILI) (17, 23.6%). Among those with ACLF, 24 (39.3%) patients died with median survival of 17.1 ±13.5 days. Mortality was significantly associated with Child Turcotte Pugh (CTP) score ≥13 (p=0.010), model for end-stage liver disease (MELD) score ≥30 (p=0.001), age >40 years (p=0.036), organ failures (OF) ≥3 (p <0.0001), portosystemic encephalopathy (PSE) (p <0.0001), renal failure (p <0.0001) and urosepsis (p <0.0001).
  
  
  CONCLUSIONS
  Acute viral hepatitis and DILI are commonest causes of ACLF. Mortality is high in ACLF patients having OF ≥3, CTP ≥13, MELD ≥30, age >40 years, PSE, renal failure and urosepsis.
authors.affiliation: Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi.
authors.forename: Abbas Ali
authors.initials: AA
authors.lastname: Tasneem
authors.affiliation: Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi.
authors.forename: Nasir Hassan
authors.initials: NH
authors.lastname: Luck
mesh_terms: D065290:Acute-On-Chronic Liver Failure / Q000175:diagnosis / Q000401:mortality* / Q000473:pathology* / Q000628:therapy; D000328:Adult; D000704:Analysis of Variance; D002423:Cause of Death; D003430:Cross-Sectional Studies; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D019694:Hepatitis B, Chronic / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D019698:Hepatitis C, Chronic / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D019693:Hepatitis, Autoimmune / Q000150:complications* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008103:Liver Cirrhosis / Q000150:complications / Q000473:pathology / Q000821:virology; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D010154:Pakistan; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis