Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis
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Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis. / Gustot, Thierry; Fernandez, Javier; Garcia, Elisabet; Morando, Filippo; Caraceni, Paolo; Alessandria, Carlo; Laleman, Wim; Trebicka, Jonel; Elkrief, Laure; Hopf, Corinna; Solís-Munoz, Pablo; Saliba, Faouzi; Zeuzem, Stefan; Albillos, Augustin; Benten, Daniel; Montero-Alvarez, José Luis; Chivas, Maria Teresa; Concepción, Mar; Córdoba, Juan; McCormick, Aiden; Stauber, Rudolf; Vogel, Wolfgang; de Gottardi, Andrea; Welzel, Tania M; Domenicali, Marco; Risso, Alessandro; Wendon, Julia; Deulofeu, Carme; Angeli, Paolo; Durand, François; Pavesi, Marco; Gerbes, Alexander; Jalan, Rajiv; Moreau, Richard; Ginés, Pere; Bernardi, Mauro; Arroyo, Vicente; CANONIC Study Investigators of the EASL–CLIF Consortium.
In: HEPATOLOGY, Vol. 62, No. 1, 07.2015, p. 243-52.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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TY - JOUR
T1 - Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis
AU - Gustot, Thierry
AU - Fernandez, Javier
AU - Garcia, Elisabet
AU - Morando, Filippo
AU - Caraceni, Paolo
AU - Alessandria, Carlo
AU - Laleman, Wim
AU - Trebicka, Jonel
AU - Elkrief, Laure
AU - Hopf, Corinna
AU - Solís-Munoz, Pablo
AU - Saliba, Faouzi
AU - Zeuzem, Stefan
AU - Albillos, Augustin
AU - Benten, Daniel
AU - Montero-Alvarez, José Luis
AU - Chivas, Maria Teresa
AU - Concepción, Mar
AU - Córdoba, Juan
AU - McCormick, Aiden
AU - Stauber, Rudolf
AU - Vogel, Wolfgang
AU - de Gottardi, Andrea
AU - Welzel, Tania M
AU - Domenicali, Marco
AU - Risso, Alessandro
AU - Wendon, Julia
AU - Deulofeu, Carme
AU - Angeli, Paolo
AU - Durand, François
AU - Pavesi, Marco
AU - Gerbes, Alexander
AU - Jalan, Rajiv
AU - Moreau, Richard
AU - Ginés, Pere
AU - Bernardi, Mauro
AU - Arroyo, Vicente
AU - CANONIC Study Investigators of the EASL–CLIF Consortium
N1 - © 2015 by the American Association for the Study of Liver Diseases.
PY - 2015/7
Y1 - 2015/7
N2 - UNLABELLED: Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation (AD) of cirrhosis, organ failure(s), and high 28-day mortality. We investigated whether assessments of patients at specific time points predicted their need for liver transplantation (LT) or the potential futility of their care. We assessed clinical courses of 388 patients who had ACLF at enrollment, from February through September 2011, or during early (28-day) follow-up of the prospective multicenter European Chronic Liver Failure (CLIF) ACLF in Cirrhosis study. We assessed ACLF grades at different time points to define disease resolution, improvement, worsening, or steady or fluctuating course. ACLF resolved or improved in 49.2%, had a steady or fluctuating course in 30.4%, and worsened in 20.4%. The 28-day transplant-free mortality was low-to-moderate (6%-18%) in patients with nonsevere early course (final no ACLF or ACLF-1) and high-to-very high (42%-92%) in those with severe early course (final ACLF-2 or -3) independently of initial grades. Independent predictors of course severity were CLIF Consortium ACLF score (CLIF-C ACLFs) and presence of liver failure (total bilirubin ≥12 mg/dL) at ACLF diagnosis. Eighty-one percent had their final ACLF grade at 1 week, resulting in accurate prediction of short- (28-day) and mid-term (90-day) mortality by ACLF grade at 3-7 days. Among patients that underwent early LT, 75% survived for at least 1 year. Among patients with ≥4 organ failures, or CLIF-C ACLFs >64 at days 3-7 days, and did not undergo LT, mortality was 100% by 28 days.CONCLUSIONS: Assessment of ACLF patients at 3-7 days of the syndrome provides a tool to define the emergency of LT and a rational basis for intensive care discontinuation owing to futility.
AB - UNLABELLED: Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation (AD) of cirrhosis, organ failure(s), and high 28-day mortality. We investigated whether assessments of patients at specific time points predicted their need for liver transplantation (LT) or the potential futility of their care. We assessed clinical courses of 388 patients who had ACLF at enrollment, from February through September 2011, or during early (28-day) follow-up of the prospective multicenter European Chronic Liver Failure (CLIF) ACLF in Cirrhosis study. We assessed ACLF grades at different time points to define disease resolution, improvement, worsening, or steady or fluctuating course. ACLF resolved or improved in 49.2%, had a steady or fluctuating course in 30.4%, and worsened in 20.4%. The 28-day transplant-free mortality was low-to-moderate (6%-18%) in patients with nonsevere early course (final no ACLF or ACLF-1) and high-to-very high (42%-92%) in those with severe early course (final ACLF-2 or -3) independently of initial grades. Independent predictors of course severity were CLIF Consortium ACLF score (CLIF-C ACLFs) and presence of liver failure (total bilirubin ≥12 mg/dL) at ACLF diagnosis. Eighty-one percent had their final ACLF grade at 1 week, resulting in accurate prediction of short- (28-day) and mid-term (90-day) mortality by ACLF grade at 3-7 days. Among patients that underwent early LT, 75% survived for at least 1 year. Among patients with ≥4 organ failures, or CLIF-C ACLFs >64 at days 3-7 days, and did not undergo LT, mortality was 100% by 28 days.CONCLUSIONS: Assessment of ACLF patients at 3-7 days of the syndrome provides a tool to define the emergency of LT and a rational basis for intensive care discontinuation owing to futility.
KW - Acute-On-Chronic Liver Failure
KW - Adult
KW - Aged
KW - Europe
KW - Humans
KW - Liver Transplantation
KW - Middle Aged
KW - Prognosis
U2 - 10.1002/hep.27849
DO - 10.1002/hep.27849
M3 - SCORING: Journal article
C2 - 25877702
VL - 62
SP - 243
EP - 252
JO - HEPATOLOGY
JF - HEPATOLOGY
SN - 0270-9139
IS - 1
ER -
