A Clinical Study About The Relationship Between Sepsis And Acute On Chronic Liver Failure

Part One Clinical study about how sepsis influences the occurrence,development and prognosis of acute on chronic liver failureBackground and Aims: Sepsis is one of the most important precipitating events of acute on chronic liver failure.A recent study carried out in European patients primarily with alcohol or hepatitis C virus shows that sepsis has no impact on the short-term prognosis of ACLF.The aim of this study was to explore how sepsis influences the occurrence,development and prognosis of ACLF.Methods: Totally 1164 consecutive hospitalized chronic liver disease patients with AD from our medical center were collected between 2005 and 2010. All patients gave a full history, complete physical examinations,laboratory tests at admission and other specific day in-hospital.Patients divided into two groups: ACLF and non-ACLF according to the CLIF-C OF criteria. Then both groups were divided into two groups according to with or without sepsis.We used clinical and biochemistry characteristics, the organ failure and 28-day and 90-day mortality data to identify differences between groups with or without sepsis.Results: Of patients assessed,283(24.3%)patients developed ACLF at admission,881(75.7%)did not have ACLF(84 developed ACLF within28-day, 797 remaining not have ACLF).There were all together 367 patients in the ACLF group.Among this group, 78 patients had sepsis as their precipitating events,107 patients developed sepsis while in hospital and 182 didn't?The 28-day mortality of ACLF-precipitated by sepsis,ACLF-developed sepsis,ACLF-without sepsis was 42.3%,55.1%,34.6%and the 90-day mortality was 55.1%,67.3%,40.1%.There were881 patients in the non-ACLF group,among this group,108 patients had sepsis as their precipitating events,81 developed sepsis while in hospital and 692 didn't?The 28-day mortality of non ACLF-precipitated by sepsis,non ACLF-developed sepsis,non ACLF-without sepsis was 8.3%,24.7%,4.0%and the 90-day mortality was 17.6%, 34.6%, 4.2%.Non-ACLF patients precipitated by sepsis or developed sepsis tend to develop ACLF much more than patients without sepsis.Conclusion: Sepsis can stimulate the development of acute on chronic liver failure,while sepsis newly developed during hospital may produce adverce effects on the short-term prognosis of ACLF and non-ACLF.However, sepsis does not have this bad effect as the precipitating event.Part two CLIF-C OF score can distinguish acute on chronic liver failure from Non-HBV related chronic liver disease with acute decompensationBackground and Aims: A recent study established a diagnostic criteria for Acute-on-Chronic Liver Failure(ACLF) in European patients primarily with alcohol or hepatitis C virus.The aim of this study was to assess the performance of the Chronic liver failure-Consortium Organ Failure score in patients with non hepatitis B virus(HBV)-related chronic liver disease with acute decompensation(AD).Methods: Totally 274 consecutive hospitalized non-HBV related chronic liver disease patients with AD from our medical center were collected between 2005 and 2010. All patients gave a full history, complete physical examinations,laboratory tests at admission. Patients divided into three groups: ACLF at admission, developed ACLF within 28-day and non-ACLF according to the CLIF-C OF criteria. We used clinical and biochemistry characteristics, the organ failure and 28-day and 90-day mortality data to define ACLF grades and identify differences between ACLF and AD.Results: Of patients assessed, 40(14.6%) had ACLF at admission, 234(85.4%)did not have ACLF(27 developed ACLF within 28-day, 207 remaining not have ACLF). The ACLF patients from both admission and 28-day developed group are younger(p<0.01), and had higher total bilirubin,serum creatinine,international normalized ratio,Alanine aminotransferase,Aspartate transaminase,Albumin,White blood cell count, model for end-stage liver disease score, model for end-stage liver disease-Sodium score,Child�Pugh score,Child-Turcotte-Pugh score than non-ACLF patients(p<0.05). The ACLF have more numbers of severe organ failure including hepatic, kidney, cerebral, coagulation, circulation and lung failure than non-ACLF patients(p?0.01). However, there were no differences between ACLF-admission and ACLF within 28-day.Twenty-eight-day mortality of ACLF-admission, ACLF within 28-day compared with non-ACLF was 40.0% vs 3.4%, 37%vs 3.4% and and90-day mortality was 55.0% vs 6.8%, 59.3% vs 6.8%, respectively.Furthermore, there were no differences of the mortality between ACLF patients from admission and 28-day diagnosed group. The characteristics mentioned above among ACLF in different grades were also significantly different.Conclusion: Acute-on-Chronic Liver Failure is a more severe syndrome among patients with acute decompensation of non-HBV related chronic liver disease,and CLIF-C OF criteria could distinguish ACLF patients from non-HBV related chronic liver disease with AD.