Related Experiment Video
Updated: Sep 15, 2025
09:44
Generation of a Rat Model of Acute Liver Failure by Combining 70% Partial Hepatectomy and Acetaminophen
Published on: November 27, 2019
10.3K
Clinical differences between HBV and alcohol related ACLF in a WGO classification multicenter study
Qian Zhang1,2, Jiaxuan Hu1,3, Shaotian Qiu1,3
1Department of Gastroenterology and Hepatology, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China.
Scientific Reports
|July 13, 2025
Summary
Acute-on-chronic liver failure (ACLF) differs by cause, with alcohol-related ACLF showing more inflammation and organ failure than hepatitis B virus (HBV)-related ACLF. Outcomes depend on chronic liver disease severity, not just the cause.
Area of Science:
- Hepatology
- Internal Medicine
- Clinical Research
Background:
- Acute-on-chronic liver failure (ACLF) presents with significant etiological variations globally, notably hepatitis B virus (HBV)-related ACLF in China and alcohol-related ACLF in Western countries.
- Understanding these etiological differences is crucial for effective patient management and outcome prediction.
Purpose of the Study:
- To systematically compare the clinical profiles and outcomes of HBV-related ACLF versus alcohol-related ACLF.
- To stratify comparisons based on the World Gastroenterology Organization (WGO) classification of underlying chronic liver disease severity (A/B/C).
- To evaluate the predictive performance of different scoring systems (MELD, MELD-Na, CLIF-C ACLF, COSSH-ACLF II) in ACLF subtypes.
Main Methods:
- A multicenter retrospective study involving 659 patients with HBV-related ACLF and 296 patients with alcohol-related ACLF.
- Patients were stratified according to WGO A/B/C classification.
- Clinical data, including inflammatory markers, infection rates, organ failures, and mortality, were analyzed and compared between etiological groups and ACLF types.
Main Results:
- Alcohol-related ACLF exhibited higher systemic inflammation, bacterial infection rates, and extrahepatic organ failures compared to HBV-related ACLF.
- HBV-related ACLF showed more pronounced acute hepatocellular injury and higher MELD/MELD-Na scores.
- Etiological differences were most distinct in type C ACLF, which had the poorest clinical profiles and high mortality (>45%) regardless of cause.
- CLIF-C ACLF and COSSH-ACLF II scores demonstrated superior prediction of outcomes in type C ACLF compared to MELD and MELD-Na scores.
Conclusions:
- The etiology of ACLF and the severity of the underlying chronic liver disease significantly influence clinical presentation and outcomes.
- Type C ACLF, characterized by extensive organ failure, carries a uniformly high mortality risk irrespective of the underlying etiology.
- Tailored management strategies addressing both the ACLF etiology and the stage of chronic liver disease are essential for improving patient survival.
