Assessment of the Predictors and Mortality in Patients of Acute-On-Chronic Liver Failure; A Prospective Study
Keywords:ACLF, mortality, etiology
Objective: To evaluate the Predictors and Mortality in Patients of Acute-On-Chronic Liver Failure (ACLF); in term of its grades at different time points to define disease resolution, enhancement, worsening, or steady or fluctuating course.
Methodology: This prospective study was conducted at gastroenterology department of Asian Institute of Medical Sciences Sindh Pakistan from January 2018 to December 2018. All the patients of acute-on-chronic liver failure (ACLF) age more then 25 years and of either gender were included. In order to determine the etiology of chronic liver disease as well as the acute triggering event, a complete history was obtained including demographic profile and specifics on clinical characteristics (jaundice, ascites, gastro-intestinal bleed, grade of encephalopathy, records of vital parameters etc.). Serum electrolytes, viral serology, autoimmune profile, liver function tests, serum creatinine, prothrombin time, and INR were among the laboratory tests performed on each patient. The patients were monitored for one month or until any in-hospital deaths occurred.
Results: A total 117 patients were studied; their average age was 40.90+2.26 years and males’ predominance (73.5%). HCV and HBV+HDV were the commonest etiological factors. Overall, 30 days mortality rate was 61.5%. Multiorgan failure, spontaneous bacterial peritonitis, renal failure, high grade hepatic encephalopathy, SIRS were significantly associated with in hospital 30 days mortality (p-0.001). In hospital mortality was also significantly higher in CTP score >18, MELD score >25, CTP classification <13 and presence of hepato-renal syndrome and need for ventilation was associated with poor outcome (p-0.001).
Conclusion: Multiorgan failure, spontaneous bacterial peritonitis, renal failure, high grade hepatic encephalopathy, SIRS and presence of hepato-renal syndrome and need for ventilation were associated with poor outcome. CTP score >18, MELD score >25, CTP classification <13 and presence of hepato-renal syndrome were observed to the significant predictors of the in-Hospital mortality in acute decompensation (AD) of cirrhosis patients.
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