Factors Associated with High Mortality in Acute on Chronic Liver Failure Patients Admitted to the Intensive Care Unit, Single Center Experience
Hepatology and Liver Transplantation Unit, Gastroenterology department, National Institute of Medical Science and Nutrition Salvador Zubiran, Mexico City, Mexico
Meeting: 2020 American Transplant Congress
Abstract number: B-173
Keywords: Infection, Liver failure, Liver transplantation, Renal failure
Session Information
Session Name: Poster Session B: Liver: Recipient Selection
Session Type: Poster Session
Date: Saturday, May 30, 2020
Session Time: 3:15pm-4:00pm
Presentation Time: 3:30pm-4:00pm
Location: Virtual
*Purpose: ACLF is a newly defined syndrome in the background of a chronic liver disease characterized by acute decompensation, organ failure and high mortality at 28 days (30-40%). The aims of this study were to investigate the clinical characteristics of hospitalized patients in the ICU with ACLF, determine the main precipitants, the associated organ failures and evaluate the short-term mortality
*Methods: Patients admitted at a tertiary hospital from 2012-2018 with a diagnosis of chronic liver failure that developed Acute on Chronic Liver Failure (ACLF) based on the EASL-CLIF Consortium definition, were included in this study. Short-term mortality was evaluated for a 90-day follow up period. In addition, ACLF precipitants, the development of organ failures and their impact on mortality were also assessed.
*Results: A total of 160 patients (55% male and 45% female) were diagnosed with ACLF. The median age was 55 years (interquartile range 42-64). The most frequent etiology was HCV (29.4%). Bacterial infection was the most predominant precipitant factor (58%). According to the number of organ failures, ACLF grade 3 was present in (56%), grade 2 (30%) and grade 1 (14%). Survival at 90-day follow-up was only 21% and decreased even more in proportion to the severity of ACLF. In addition, cox modeling demonstrated that kidney (HR=3.24, 95% CI 2.27-4.72) and cerebral (HR=1.61, 95% CI 1.13-2.29) organ failures and male sex (HR=1.83, 95% CI 1.28-2.61) were independent predictors of mortality.
*Conclusions: ACLF is a frequent syndrome among chronic liver disease patients. It has a high short-term mortality especially in male patients, when infection is the precipitant, and if brain and renal failure develop. Patients without these characteristics have a better prognosis and may be better candidates to receive a liver transplant
To cite this abstract in AMA style:
Guerrero OMendez, Rodas DACalle, Alvarez ECervantes, Arenas EAlatorre, Escobar JPerez, Hernandez AEstanes, Alvarez NNavarro, Torre A. Factors Associated with High Mortality in Acute on Chronic Liver Failure Patients Admitted to the Intensive Care Unit, Single Center Experience [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/factors-associated-with-high-mortality-in-acute-on-chronic-liver-failure-patients-admitted-to-the-intensive-care-unit-single-center-experience/. Accessed May 12, 2025.« Back to 2020 American Transplant Congress