The clinical characteristics and prognosis of acute-on-chronic liver failure induced by different precipitating factors

Abstract

Abstract: Objective To analyze the clinical characteristics and prognostic differences of acute-on-chronic liver failure (ACLF) patients induced by different precipitating factors, in order to provide reference for disease diagnosis and treatment. Methods The clinical data of ACLF patients admitted to Beijing You’an Hospital affiliated with Capital Medical University from January 2015 to February 2023 were retrospectively analyzed. Patients were divided into hepatic-ACLF and extrahepatic-ACLF based on the precipitating factors. The clinical features of hepatic- and extrahepatic-ACLF patients were analyzed. T-tests or Mann-Whitney U tests were used for the comparison of continuous data. Chi-square tests or Fisher's exact tests were used for the comparison of categorical data. Log-rank tests, Landmark analysis, and COX proportional hazards models were used to analyze the differences and influencing factors of 28-day and 90-day prognoses between hepatic- and extrahepatic-ACLF patients. Results A total of 376 ACLF patients with clear precipitating factors were collected. Among patients with ACLF caused by hepatitis B, HBV reactivation was the main cause (107, 41.6%). Among non-hepatitis B ACLF patients, infection was the main precipitating factor (48, 40.3%). ACLF induced by HBV reactivation and drugs was defined as hepatic-ACLF, while ACLF induced by infections and gastrointestinal bleeding was defined as extrahepatic-ACLF. A higher proportion of cirrhotic patients developed ACLF due to extrahepatic factors, with a statistically significant difference (85.7% vs 67.7%, χ²=15.411, P<0.001). No statistical difference in 28-day and 90-day transplant-free survival rates between hepatic and extrahepatic-ACLF patients. By subgroup analysis based on the underlying liver disease it was revealed that extrahepatic factors were an independent influencing factor for the 90-day prognosis in patients with decompensated cirrhosis. Conclusion Compared to non-cirrhotic patients, patients with cirrhosis (compensated and decompensated) are more likely to develop ACLF induced by extrahepatic factors. Compared with intrahepatic triggers, the 90-day mortality rate of ACLF with decompensated cirrhosis caused by extrahepatic triggers is lower.

Key words: Acute-on-chronic liver failure, Precipitating events, Clinical characteristics, Prognosis

YANG Yan-rong, WU Yu, LI Shan-shan, ZOU Huai-bin, DUAN Zhong-ping, XU Man-man, CHEN Yu. The clinical characteristics and prognosis of acute-on-chronic liver failure induced by different precipitating factors[J]. Chinese Hepatolgy, 2024, 29(11): 1319-1324.

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