Abstract: Objective To investigate the long-term survival status of patients with acute-on-chronic liver failure (ACLF). Methods This was a retrospective cohort study. A total of 167 patients diagnosed as ACLF were enrolled. The survival status and laboratory examination results at 3 months and 1 year after follow-up were recorded, and the changes of short-term and long-term survival status were observed. The long-term prognosis of ACLF patients (≥24 weeks) was divided into 5 grades: Grade I was an ideal outcome: without cirrhosis; Grade II was a satisfactory outcome: compensatory cirrhosis, manifested as reversible or long-term compensatory cirrhosis; Grade III was an acceptable outcome: decompensated cirrhosis, manifested as decompensated cirrhosis or chronic liver failure; Grade IV was the survival outcome after transplantation; Grade V was the death outcome. Results A total of 167 patients with ACLF were enrolled, with a median age of 45 years (39, 53) and 136 cases (81.4%) were male. The etiology of 123 cases (73.7%) was chronic hepatitis B virus (HBV) infection which was the main cause, and the other 44 cases were caused by other diseases. At baseline, 68 cases (40.7%) without liver cirrhosis, and 99 cases (59.3%) with liver cirrhosis. Three months after liver transplantation, 16 cases (9.6%) survived and 56 cases (33.5%) died. At 1 year after liver transplantation, 15 cases (9.0%) survived and 67 cases (40.1%) died. After a 3 months follow-up among the 68 patients without liver cirrhosis, 11 patients (16.2%) still without liver cirrhosis, 23 cases (33.8%) with compensated cirrhosis, 14 cases (20.6%) with decompensated cirrhosis, 5 cases (7.4%) survived after liver transplantation, and 15 cases (22.1%) died. Continue the follow-up to 1 year, among the 11 patients without cirrhosis at 3 months, 8 of which were still in non-cirrhotic state, 1 of which developed compensated cirrhosis and 2 of which developed decompensated cirrhosis; among the 23 patients with compensatory cirrhosis at 3 months, 15 of which without liver cirrhosis, 5 of which still with compensatory cirrhosis, and 3 of which developed decompensated cirrhosis; among the 14 patients with decompensated cirrhosis at 3 months, 3 of which without liver cirrhosis, 9 of which with compensated cirrhosis and 2 of which still with decompensated cirrhosis. Among the 5 patients who survived after liver transplantation at 3 months, 1 patient died. After a 3 months follow-up among the 99 patients with liver cirrhosis, all of them still with liver cirrhosis 14 patients (14.1%) with compensated cirrhosis, 33 patients (33.3%) with decompensated cirrhosis, 11 patients (11.1%) survived after liver transplantation and 41 patients (41.1%) died. Continue the follow-up to 1 year, among the 14 patients with compensatory cirrhosis at 3 months, 11 of which still with compensatory cirrhosis and 3 of which developed decompensated cirrhosis; among the 33 patients with decompensated cirrhosis at 3 months, 13 of which with compensatory cirrhosis, 10 of which still with decompensated cirrhosis, 1 of which survived after liver transplantation and 9 of which died after liver transplantation. Among the 11 patients who survived after liver transplantation at 3 months, 1 patient died. Conclusion The short-term and long-term survival status of patients with ACLF is uncertain, which requires close follow-up and active treatment. The ACLF patients without cirrhosis at baseline have a longer survival time and a better survival state after active treatment.

Key words: Acute-on-chronic liver failure, Long term survival status, Long-term prognosis and outcome