Characteristics Of Acute-on-chronic Liver Failure Group In Multicenters Prospective Study

Background and aims: Cirrhotic Acute-on-chronic liver failure(ACLF)is a distinct entity encompassing the acute deterioration of liver function,culminating in multiple organ failure and high short-term mortality(mortality at 28 days more than 15%).However prospective data from eastern types of chronic liver disease which HBV(hepatitis B virus)infection was the main etiology was absent.Methods: A multicenters prospective study for ACLF was performed in 14 liver centers in China.1458 hospitalized cirrhotic and non-cirrhotic patients with acute liver injury(ALI)or acute decompensation(AD)were enrolled from 2015.1.1 to 2015.12.31.Clinical data were analyzed in all consecutive patients and serum samples of admission were tested.Results: HBV was the main etiology of 1458 patients with chronic liver disease and counted for 67.7%.Prevalence of ACLF was 18.2% based on CLIF-C OFs(Chronic liver failure consortium-organ failure score)criteria.1008 patients were cirrhotic and 208(20.6%)of them were diagnosed as ACLF,mortality at 28-day and 90-day were 38.4% and 52.5% respectively;In the rest 450 non-cirrhotic patients,57(12.7%)patients progressed to ACLF,mortality was 21.1% at 28 days,and 24.6% at 90 days.Non-ACLF patients(cirrhotic and non-cirrhotic group)had mortality less than 5% either at 90 days.In cirrhotic ACLF patients,multiorgan failure was obviously related to high short term mortality.And ACLF group had obviously higher serum level of indicators reflecting systemic inflammation.Conclusion: CLIF-C OFs could distinguish eastern type of ACLF patients from chronic liver disease.Multiorgan failure was the main reason for short term prognosis.Systemic inflammation may be the common feature of ACLF.