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Clinical Course and Outcome Patterns of Acute-on-chronic Liver Failure: A Multicenter Retrospective Cohort Study
Man-Man Xu1,2, Ming Kong1,2, Peng-Fei Yu1,2
1Fourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, China.
This study analyzed 453 acute-on-chronic liver failure (ACLF) patients, developing dynamic prognostic criteria based on prothrombin activity (PTA) and total bilirubin (TB) trends. These criteria aid in predicting ACLF patient outcomes and improving treatment strategies.
Area of Science:
- Hepatology
- Internal Medicine
- Clinical Research
Background:
- Acute-on-chronic liver failure (ACLF) is a severe condition with high short-term mortality.
- ACLF involves acute decompensation of liver function in patients with pre-existing chronic liver disease.
Purpose of the Study:
- To investigate the clinical course of ACLF patients at specific time points.
- To propose novel dynamic prognostic criteria for ACLF.
Main Methods:
- Retrospective multicenter study of 453 ACLF patients.
- 12-week follow-up to assess clinical course based on prothrombin activity (PTA) and total bilirubin (TB) variations.
- Defined clinical course patterns: recovery, improvement, worsening, or steady.
Main Results:
- 51% of patients showed PTA resolution by 12 weeks.
- PTA and TB trends were correlated, with distinct patterns observed for resolved, improved, and steady/worsening PTA.
- Dynamic prognostic criteria were developed using PTA/TB clinical course and outcomes at 4 and 12 weeks.
Conclusions:
- Proposed dynamic prognostic criteria include rapid progression, slow progression, rapid recovery, slow recovery, and slow persistence.
- These criteria provide a foundation for precise prognosis prediction in ACLF.
- The criteria aim to improve therapeutic strategies for ACLF patients.
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