Journal of Clinical and Translational Hepatology

Journal of Clinical and Translational Hepatology

Thursday, 12 / 09 / 2021

Articles

Abstract

ORIGINAL ARTICLE

Clinical Course and Outcome Patterns of Acute-on-chronic Liver Failure: A Multicenter Retrospective Cohort Study

Man-Man Xu1,2,#, Ming Kong1,2,#, Peng-Fei Yu1,2, Ying-Ying Cao3, Fang Liu3, Bing Zhu4, Yi-Zhi Zhang1,2, Wang Lu1,2, Huai-Bin Zou1,2, Bin-Wei Duan5, Shao-Li You4, Shao-Jie Xin4, Tao Han3, Zhong-Ping Duan1,2 and Yu Chen1,2,*

1  Fourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You’an Hospital Affiliated to Capital Medical University, Beijing, China
2  Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China
3  Department of Hepatology, The Third Central Clinical College of Tianjin Medical University, Tianjin, China
4  Liver Failure Treatment and Research Center, The Fifth Medical Center of Chinese PLA General Hospital, Beijing, China
5  Department of General Surgery, Beijing You’an Hospital Affiliated to Capital Medical University, Beijing, China
#Contributed equally to this work.
*Correspondence to:Yu Chen, Fourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You’an Hospital Affiliated to Capital Medical University, No. 8, Xi Tou Tiao, Youanmenwai Street, Fengtai District, Beijing 100069, China. ORCID:https://orcid.org/0000-0001-7612-3240. Tel: +86-10-8399-7123, E-mail: This email address is being protected from spambots. You need JavaScript enabled to view it.

Journal of Clinical and Translational Hepatology 2021;9(5):626-634 DOI: 10.14218/JCTH.2020.00179
Received:December 23, 2020 Accepted:March 23, 2021 Published online:April 16, 2021

Abstract

Background and Aims:Acute-on-chronic liver failure (ACLF) is acute decompensation of liver function in the setting of chronic liver disease, and characterized by high short-term mortality. In this study, we sought to investigate the clinical course of patients at specific time points, and to propose dynamic prognostic criteria.

Methods:We assessed the clinical course of 453 patients with ACLF during a 12-week follow-up period in this retrospective multicenter study. The clinical course of patients was defined as disease recovery, improvement, worsening or steady patterns based on the variation tendency in prothrombin activity (PTA) and total bilirubin (TB) at different time points.

Results:Resolution of PTA was observed in 231 patients (51%) at 12 weeks after the diagnosis of ACLF. Among the remaining patients, 66 (14.6%) showed improvement and 156 (34.4%) showed a steady or worsening course. In patients with resolved PTA, the clinical course of TB exhibited resolved pattern in 95.2%, improved in 3.9%, and steady or worse in 0.8%. Correspondingly, in patients with improved PTA, these values for TB were 28.8%, 27.3%, and 43.9%, respectively. In patients with steady or worsening PTA, these values for TB were 5.7%, 32.3%, and 65.6%, respectively. Dynamic prognostic criteria were developed by combining the clinical course of PTA/TB and the clinical outcomes at 4 and 12 weeks after diagnosis in ACLF patients.

Conclusions:We propose the following dynamic prognostic criteria: rapid progression, slow progression, rapid recovery, slow recovery, and slow persistence, which lay the foundation for precise prediction of prognosis and the improvement of ACLF therapy.

Keywords

Acute-on-chronic liver failure, Clinical course, Outcome patterns, Retrospective cohort study

Journal of Clinical and Translational Hepatology 2021 vol. 9, 626-634  [ Html  ] [ PDF Full-text ]

© 2021 Authors. This is an Open Access article distributed under the terms of the  Creative Commons Attribution-Noncommercial 4.0 License(CC BY-NC 4.0), permitting all non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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