Prevalence of acute on chronic liver failure, underlying etiology and precipitating factors
Journal Title: International Archives of Integrated Medicine - Year 2019, Vol 6, Issue 4
Abstract
Background: Acute on chronic liver failure (ACLF) was first described in 1995 as a clinical syndrome distinct to classic acute decompensation. Characterized by complications of decompensation, ACLF occurs on a background of chronic liver disease and is associated with high rates of organ failure and significant short-term mortality estimated between 45% and 90%. Despite the clinical relevance of the condition, it still remains largely undefined with continued disagreement regarding its precise etiological factors, clinical course, prognostic criteria, and management pathways. It is concerning that, despite our relative lack of understanding of the condition, the burden of ACLF among cirrhotic patients remains significant with an estimated prevalence of 30.9%. Aim of the study: The present study was aimed at estimating the prevalence of acute on chronic liver failure in our institute, etiology of underlying chronic liver disease, precipitating acute event and mortality rate. Materials and methods: 150 patients admitted and treated with the diagnosis of ACLF in the Institute of Hepatobiliary Sciences, Rajiv Gandhi Government General Hospital during the period from December 2016 to November 2018 were included in the study. Their data regarding etiology of chronic liver disease, precipitating acute events and mortality were collected and analyzed. Results: Out of 386 patients, 150 patients were admitted with acute on chronic liver failure with a prevalence of 39%. In 41% of patients, infection was the precipitating factor for ACLF either in the form of Sepsis, spontaneous bacterial peritonitis, Lower respiratory tract infection or skin, and soft tissue infections. Alcohol was the second most precipitating factor (32%), followed by upper gastrointestinal hemorrhage (12%) and drugs (2%). No precipitating cause could be identified in 12.7% of patients. Mortality rate was high in ACLF grade 3 (95%), followed by ACLF grade 2 (62%) and ACLF grade 1 (15%). Conclusion: ACLF is a dynamic syndrome presenting with single, two or more organ failure in a patient with chronic liver disease following a triggering event and associated with high short term mortality. In our hospital, the prevalence of ACLF was 39% and the overall mortality rate was 83%. Infection and alcohol were found to be important precipitating factors. A multi-centre study involving a larger number of patients are needed to know the clinical characteristics, other precipitating factors and to form a standard treatment protocol for this dynamic syndrome.
Authors and Affiliations
Premkumar K, Krishnasamy Narayanasamy
Keywords
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