Session Title: Category 2b. CIRRHOSIS AND ITS COMPLICATIONS: b. CLINICAL ASPECTS
Presentation Date: Apr 15, 2010
A PROSPECTIVE COHORT STUDY INVESTIGATING THE NATURAL HISTORY OF ACUTE-ON-CHRONIC LIVER FAILURE
F. Nevens1*, A. Katoonizadeh1, C. Verslype1, G. Maleux2, T. Roskams3, A. Wilmer4, W. Laleman1
1Hepatology, 2Interventionale Radiology, 3Morphology and Molecular Pathology, UZ Gasthuisbrg, Leuven, 4Medical Intensive Care Unit, UZ Gasthuisbrg, Leuven, Belgium. *firstname.lastname@example.org
Background and aims: Acute-on-chronic liver failure (AoCLF) has the potential to recuperate. The incidence, the clinical characteristics and the natural history has never been investigated in a prospective way.
Material and methods: In a prospective cohort study from 2002 until 2007, the characteristics of AoCLF were compared with chronic liver failure due to decompensated cirrhosis (CHD). AoCLF was defined as a rapid deterioration of liver function evolving to multiorgan failure in patients with previously compensated liver disease. In patients fulfilling these criteria, all patients received a transjugular biopsy at admission. In order to obtain a homogeneous group of patients only patients with histologically-proven alcoholic cirrhosis were selected.
Results: 250 patients were screened: CHD n= 180 and AoCLF n= 70 (28%). Alcoholic liver disease was observed in respectively 72/180 (40%) of the CHD and 61/70 (87%) of AoCLF. In the group of CHD 24 pts were excluded predominanthly due to HCC: 11/72 (15%) and in the group of AoCLF : 7/61 (11%) due to absence of cirrhosis on histology.
In hospital mortality was significantly higher in the AoCLF group (46%) (25/54) vs CHD group (10%) (5/48) (P=0.0001). During follow-up respectively 7 % (4/54) and 30 % (14/48) of the patients with AoCLF and CHD needed liver transplantation of which all survived. The transplant-free survival of both groups is given in Figure 1. Two patients in each groups were lost from follow-up. Patients with AoCLF who survived hospital-stay had less ominous prognosis. The difference in transplant-free survival disappeared after 1 year (survival at 3 months: 44.2 vs 82.2% [AoCLF vs CHD] (P=0,0002); at 6 months: 36,5 vs 60% (P=0,029); at 12 months: 36,5 vs 53% (P=0.132) and at 5 years: 29,7 vs 34,4 % (P=0,767).
Conclusions: The majority of patients with AoCLF in our unit suffer from alcoholic cirrhosis. AoCLF represents a quarter of the population of patients with alcoholic cirrhosis (without HCC) with liver failure. The in-hospital mortality of AoCLF is high but those patients who survived the period of acute liver failure have a good prognosis.