Cargando…

Acute on chronic liver failure: A South Australian experience

BACKGROUND AND AIM: Acute on chronic liver failure (ACLF) is a clinical syndrome described in patients with acute decompensation (AD) of cirrhosis, characterized by organ failures and high mortality. Intensive management, including liver transplantation (LT), has been shown to improve survival. To a...

Descripción completa

Detalles Bibliográficos
Autores principales: Madigan, Shauna, Tashkent, Yasmina, Trehan, Sharad, Muller, Kate, Wigg, Alan, Woodman, Richard, Ramachandran, Jeyamani
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wiley Publishing Asia Pty Ltd 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615173/
https://www.ncbi.nlm.nih.gov/pubmed/37908287
http://dx.doi.org/10.1002/jgh3.12974
_version_ 1785129166668038144
author Madigan, Shauna
Tashkent, Yasmina
Trehan, Sharad
Muller, Kate
Wigg, Alan
Woodman, Richard
Ramachandran, Jeyamani
author_facet Madigan, Shauna
Tashkent, Yasmina
Trehan, Sharad
Muller, Kate
Wigg, Alan
Woodman, Richard
Ramachandran, Jeyamani
author_sort Madigan, Shauna
collection PubMed
description BACKGROUND AND AIM: Acute on chronic liver failure (ACLF) is a clinical syndrome described in patients with acute decompensation (AD) of cirrhosis, characterized by organ failures and high mortality. Intensive management, including liver transplantation (LT), has been shown to improve survival. To address the limited Australian data on ACLF, we describe the prevalence, clinical profile, and outcome of ACLF in an Australian cohort of hospitalized patients. METHODS: A retrospective review of hepatology admissions in a tertiary hospital from 1 January 2017 to 31 December 2019 identified AD and ACLF cohorts, as defined by the European Association for Study of the Liver definition. Patient characteristics, clinical course, survival at 28‐ and 90‐day survival, and feasibility of LT were analyzed. RESULTS: Among the 192 admissions with AD, 74 admissions (39%) met ACLF criteria. A prior diagnosis of alcohol‐related cirrhosis was highly prevalent in both cohorts. Grade‐1 ACLF was the most frequent (60%), with renal failure being the commonest organ failure; 28‐day (23% vs 2%, P = <0.001) and 90‐day mortality (36% vs 16%, P = 0.002) were higher in ACLF than AD. Due to ongoing alcohol use disorder (AUD), only six patients underwent LT assessment during ACLF admission. CONCLUSION: ACLF was common in our cohort of cirrhosis with AD and was associated with high mortality. AUD despite prior cirrhosis diagnosis was a barrier to LT. Prioritization of ACLF patients for LT after addressing AUD and relaxation of the 6‐month abstinence rule may improve ACLF survival and should be addressed in prospective studies.
format Online
Article
Text
id pubmed-10615173
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher Wiley Publishing Asia Pty Ltd
record_format MEDLINE/PubMed
spelling pubmed-106151732023-10-31 Acute on chronic liver failure: A South Australian experience Madigan, Shauna Tashkent, Yasmina Trehan, Sharad Muller, Kate Wigg, Alan Woodman, Richard Ramachandran, Jeyamani JGH Open Original Articles BACKGROUND AND AIM: Acute on chronic liver failure (ACLF) is a clinical syndrome described in patients with acute decompensation (AD) of cirrhosis, characterized by organ failures and high mortality. Intensive management, including liver transplantation (LT), has been shown to improve survival. To address the limited Australian data on ACLF, we describe the prevalence, clinical profile, and outcome of ACLF in an Australian cohort of hospitalized patients. METHODS: A retrospective review of hepatology admissions in a tertiary hospital from 1 January 2017 to 31 December 2019 identified AD and ACLF cohorts, as defined by the European Association for Study of the Liver definition. Patient characteristics, clinical course, survival at 28‐ and 90‐day survival, and feasibility of LT were analyzed. RESULTS: Among the 192 admissions with AD, 74 admissions (39%) met ACLF criteria. A prior diagnosis of alcohol‐related cirrhosis was highly prevalent in both cohorts. Grade‐1 ACLF was the most frequent (60%), with renal failure being the commonest organ failure; 28‐day (23% vs 2%, P = <0.001) and 90‐day mortality (36% vs 16%, P = 0.002) were higher in ACLF than AD. Due to ongoing alcohol use disorder (AUD), only six patients underwent LT assessment during ACLF admission. CONCLUSION: ACLF was common in our cohort of cirrhosis with AD and was associated with high mortality. AUD despite prior cirrhosis diagnosis was a barrier to LT. Prioritization of ACLF patients for LT after addressing AUD and relaxation of the 6‐month abstinence rule may improve ACLF survival and should be addressed in prospective studies. Wiley Publishing Asia Pty Ltd 2023-10-03 /pmc/articles/PMC10615173/ /pubmed/37908287 http://dx.doi.org/10.1002/jgh3.12974 Text en © 2023 The Authors. JGH Open published by Journal of Gastroenterology and Hepatology Foundation and John Wiley & Sons Australia, Ltd. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.
spellingShingle Original Articles
Madigan, Shauna
Tashkent, Yasmina
Trehan, Sharad
Muller, Kate
Wigg, Alan
Woodman, Richard
Ramachandran, Jeyamani
Acute on chronic liver failure: A South Australian experience
title Acute on chronic liver failure: A South Australian experience
title_full Acute on chronic liver failure: A South Australian experience
title_fullStr Acute on chronic liver failure: A South Australian experience
title_full_unstemmed Acute on chronic liver failure: A South Australian experience
title_short Acute on chronic liver failure: A South Australian experience
title_sort acute on chronic liver failure: a south australian experience
topic Original Articles
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10615173/
https://www.ncbi.nlm.nih.gov/pubmed/37908287
http://dx.doi.org/10.1002/jgh3.12974
work_keys_str_mv AT madiganshauna acuteonchronicliverfailureasouthaustralianexperience
AT tashkentyasmina acuteonchronicliverfailureasouthaustralianexperience
AT trehansharad acuteonchronicliverfailureasouthaustralianexperience
AT mullerkate acuteonchronicliverfailureasouthaustralianexperience
AT wiggalan acuteonchronicliverfailureasouthaustralianexperience
AT woodmanrichard acuteonchronicliverfailureasouthaustralianexperience
AT ramachandranjeyamani acuteonchronicliverfailureasouthaustralianexperience