Characteristics and Discrepancies in Acute-on-Chronic Liver Failure: Need for a Unified Definition

To investigate the prevalence, mortalities, and patient characteristics of Acute-on-chronic liver failure (ACLF) according to the AARC (Asian Pacific Association for the Study of the Liver ACLF Research Consortium) and European Association for the Study of the Liver CLIF-C (Chronic Liver Failure Con...

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Vydané v:PLOS ONE Ročník 11; číslo 1; s. e0146745
Hlavní autori: Kim, Tae Yeob, Song, Do Seon, Kim, Hee Yeon, Sinn, Dong Hyun, Yoon, Eileen L., Kim, Chang Wook, Jung, Young Kul, Suk, Ki Tae, Lee, Sang Soo, Lee, Chang Hyeong, Kim, Tae Hun, Kim, Jeong Han, Choe, Won Hyeok, Yim, Hyung Joon, Kim, Sung Eun, Baik, Soon Koo, Lee, Byung Seok, Jang, Jae Young, Suh, Jeong Ill, Kim, Hyoung Su, Nam, Seong Woo, Kwon, Hyeok Choon, Kim, Young Seok, Kim, Sang Gyune, Chae, Hee Bok, Yang, Jin Mo, Sohn, Joo Hyun, Lee, Heon Ju, Park, Seung Ha, Han, Byung Hoon, Choi, Eun Hee, Kim, Chang H., Kim, Dong Joon
Médium: Journal Article
Jazyk:English
Vydavateľské údaje: United States Public Library of Science (PLoS) 20.01.2016
Public Library of Science
Predmet:
Acute-On-Chronic Liver Failure
Acute-On-Chronic Liver Failure - diagnosis
Acute-On-Chronic Liver Failure - mortality
Adult
Aged
Care and treatment
Consortia
Diagnostic systems
Disease-Free Survival
Failure
Health aspects
Hepatitis
Hepatology
Hospitals
Humans
Internal medicine
Liver
Liver cirrhosis
Liver diseases
Liver failure
Medical prognosis
Medicine
Middle Aged
Mortality
Patient outcomes
Patients
Physicians
Prevalence
Q
R
Research Article
Science
Short term
South Korea
Survival
Survival Rate
Transplants & implants
South Korea
ISSN:1932-6203, 1932-6203
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Popis
Shrnutí:To investigate the prevalence, mortalities, and patient characteristics of Acute-on-chronic liver failure (ACLF) according to the AARC (Asian Pacific Association for the Study of the Liver ACLF Research Consortium) and European Association for the Study of the Liver CLIF-C (Chronic Liver Failure Consortium) definitions. We collected retrospective data for 1470 hospitalized patients with chronic liver disease (CLD) and acute deterioration between January 2013 and December 2013 from 21 university hospitals in Korea. Of the patients assessed, the prevalence of ACLF based on the AARC and CLIF-C definitions was 9.5% and 18.6%, respectively. The 28-day and 90-day mortality rates were higher in patients with ACLF than in those without ACLF. Patients who only met the CLIF-C definition had significantly lower 28-day and 90-day survival rates than those who only met the AARC definition (68.0% vs. 93.9%, P<0.001; 55.1% vs. 92.4%, P<0.001). Among the patients who had non-cirrhotic CLD, the 90-day mortality of the patients with ACLF was higher than of those without ACLF, although not significant (33.3% vs. 6.0%, P = 0.192). Patients with previous acute decompensation (AD) within 1- year had a lower 90-day survival rate than those with AD more than 1 year prior or without previous AD (81.0% vs. 91.9% or 89.4%, respectively, all P<0.001). Patients who had extra-hepatic organ failure without liver failure had a similar 90-day survival rate to those who had liver failure as a prerequisite (57.0% vs. 60.6%, P = 0.391). The two ACLF definitions result in differences in mortality and patient characteristics among ACLF patients. We suggest that non-cirrhotic CLD, previous AD within 1 year, and extra-hepatic organ failure should be included in the ACLF diagnostic criteria. In addition, further studies are necessary to develop a universal definition of ACLF.
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Competing Interests: The authors have declared that no competing interests exist.
Conceived and designed the experiments: TYK DSS HYK DHS ELY CWK YKJ DJK. Performed the experiments: KTS SSL CHL THK JHK WHC HJY SEK SKB BSL JYJ JIS HSK SWN HCK YSK SGK HBC JMY JHS HJL SHP BHH. Analyzed the data: TYK DSS EHC DJK. Contributed reagents/materials/analysis tools: CHK DJK. Wrote the paper: TYK DSS DJK.
ISSN:1932-6203
1932-6203
DOI:10.1371/journal.pone.0146745