Acute-On-Chronic Liver Failure (ACLF) in a Tertiary Care Hospital in Resource Constrained Region

Introduction: Acute-On-Chronic Liver Failure (ACLF) is an emerging entity. There is limited data on ACLF in the literature. The present study was undertaken to analyze the clinical profile and natural course of ACLF patients. Methods: ACLF was defined as per modified Asian Pacific Association for the Study of Liver (APASL) consensus criteria 2008. Patients fulfilling the criteria were included and prospectively evaluated for three months to study short term outcome. Results: Out of 159 patients with ACLF (mean age: 46.06±11.64 years; male: female-139:20), 38.36% cases had prior decompensation, whereas 61.63% presented first time as ACLF. Etiologies of cirrhosis were alcohol, cryptogenic and chronic hepatitis B virus infection in 67.29%, 22% and 10.69% cases respectively. Active alcohol drinking within 4 weeks (43%) followed by bacterial infection (37.39%) ware the common acute insults. Only 122 cases could be followed up, out of which 72.13% cases died by 3 months (Early mortality). Most of deaths occurred in alcoholics compared to non alcoholics (80% vs. 55.88%; p=0.007). Early mortality was significantly higher in cases with prior decompensation compared to newly diagnosed ACLF cases (84.78% vs. 64.47%; p=0.01). Early mortality was not significantly different between cases with single and multiple acute predispositions (p=0.13). The mean CTP and MELD score were 12.33±1.27 and 27.64±6.81 respectively. The prognostic markers (MELD, MELD-Na, CTP) were not significantly different between survivors and non-survivors. Conclusion: ACLF patients in our region had high short term mortality with majority of death in alcoholics and in cases with prior decompensation. Alcohol intake and bacterial infections were mainly responsible for acute decompensation in our region.