Characterization of acute-on-chronic liver diseases: A multicenter prospective cohort study

Author:

Zhang Yuan-Yao,Luo Sen,Li Hai,Sun Shu-Ning,Wang Xian-Bo,Zheng Xin,Huang Yan,Li Bei-Ling,Gao Yan-Hang,Qian Zhi-Ping,Liu Feng,Lu Xiao-Bo,Liu Jun-Ping,Ren Hao-Tang,Zheng Yu-Bao,Yan Hua-Dong,Deng Guo-Hong,Qiao Liang,Zhang Yan,Gu Wen-Yi,Xiang Xiao-Mei,Zhou Yi,Hou Yi-Xin,Zhang Qun,Xiong Yan,Zou Cong-Cong,Chen Jun,Huang Ze-Bing,Jiang Xiu-Hua,Qi Ting-Ting,Chen Yuan-Yuan,Gao Na,Liu Chun-Yan,Yuan Wei,Mei Xue,Li Jing,Li Tao,Zheng Rong-Jiong,Zhou Xin-Yi,Zhao Jun,Meng Zhong-Ji

Abstract

BACKGROUND Acute-on-chronic liver disease (AoCLD) accounts for the majority of patients hospitalized in the Department of Hepatology or Infectious Diseases. AIM To explore the characterization of AoCLD to provide theoretical guidance for the accurate diagnosis and prognosis of AoCLD. METHODS Patients with AoCLD from the Chinese Acute-on-Chronic Liver Failure (ACLF) study cohort were included in this study. The clinical characteristics and outcomes, and the 90-d survival rate associated with each clinical type of AoCLD were analyzed, using the Kaplan-Meier method and the log-rank test. RESULTS A total of 3375 patients with AoCLD were enrolled, including 1679 (49.7%) patients with liver cirrhosis acute decompensation (LC-AD), 850 (25.2%) patients with ACLF, 577 (17.1%) patients with chronic hepatitis acute exacerbation (CHAE), and 269 (8.0%) patients with liver cirrhosis active phase (LC-A). The most common cause of chronic liver disease (CLD) was HBV infection (71.4%). The most common precipitants of AoCLD was bacterial infection (22.8%). The 90-d mortality rates of each clinical subtype of AoCLD were 43.4% (232/535) for type-C ACLF, 36.0% (36/100) for type-B ACLF, 27.0% (58/215) for type-A ACLF, 9.0% (151/1679) for LC-AD, 3.0% (8/269) for LC-A, and 1.2% (7/577) for CHAE. CONCLUSION HBV infection is the main cause of CLD, and bacterial infection is the main precipitant of AoCLD. The most common clinical type of AoCLD is LC-AD. Early diagnosis and timely intervention are needed to reduce the mortality of patients with LC-AD or ACLF.

Publisher

Baishideng Publishing Group Inc.

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