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Published on: November 27, 2019
Hepatic Encephalopathy Severity and Mortality Risk Stratification in Alcohol-Related Acute-on-Chronic Liver Failure
Tijana Glisic1,2, Bojan Korica1, Branko Beronja3
1Clinic of Gastroenterology and Hepatology, University Clinical Center of Serbia, 11000 Belgrade, Serbia.
Diagnostics (Basel, Switzerland)
|June 12, 2026
Summary
Higher-grade hepatic encephalopathy (HE) in alcohol-related acute-on-chronic liver failure (ACLF) patients admitted to the ICU is linked to increased short-term mortality. Acute kidney injury and higher severity scores also predict poor outcomes.
Area of Science:
- Hepatology
- Critical Care Medicine
- Gastroenterology
Background:
- Acute-on-chronic liver failure (ACLF) presents with multiple organ failure and high short-term mortality.
- Hepatic encephalopathy (HE) is a common complication of ACLF.
- Alcohol-related liver disease is a significant cause of ACLF.
Purpose of the Study:
- To investigate the association between the severity of HE upon admission and short-term mortality in patients with alcohol-related ACLF.
- To identify predictors of short-term mortality in this patient population.
Main Methods:
- A cohort of 100 patients with alcohol-related ACLF and HE admitted to the intensive care unit (ICU) was studied.
- HE severity was assessed using the West Haven criteria.
- Laboratory biomarkers, length of stay (LOS), acute kidney injury (AKI), APACHE II, CLIF-C OF, and SOFA scores were analyzed for mortality risk.
Main Results:
- Higher-grade HE was significantly associated with increased total hospital LOS, 7-day, and 28-day mortality.
- Patients with higher-grade HE had significantly higher CLIF-C OF, SOFA, and APACHE II scores.
- Kaplan-Meier survival analysis showed reduced survival in patients with higher-grade HE (log-rank p < 0.001).
- AKI was independently associated with short-term mortality.
Conclusions:
- Higher-grade HE is a significant predictor of poorer short-term survival in alcohol-related ACLF patients.
- AKI and elevated CLIF-C OF, SOFA, and APACHE II scores are associated with poor outcomes and aid in mortality risk stratification.
- Hospital and ICU length of stay are markers of clinical trajectory rather than baseline prognostic predictors.
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