Outcomes of Multiple Organ Dysfunction Syndrome in Patients with Acute and Acute-on-Chronic Liver Failure in China: A Single Center Retrospective Cohort Study

Abstract

Abstract Acute liver failure (ALF) and acute-on-chronic liver failure (ACLF) pose significant threats to patient prognosis, often leading to multiple organ dysfunction syndrome (MODS), which is characterized by simultaneous dysfunction of two or more organ systems and significantly heightens the risk of mortality. Standard strategies for managing organ complications in critical illness may not always be suitable for patients with liver failure (LF).This study aims to investigate the outcomes of MODS in patients with ALF and ACLF in China, while also identifying factors influencing mortality and prognosis. We conducted a retrospective cohort study at a specialized tertiary hospital for liver diseases in Beijing, China, spanning from June 1, 2009, to May 31, 2022.Risk factors were assessed through univariate and multivariate analyses using logistic regression. Cumulative 90-day mortality rates between the ACLF and ALF groups were compared using Cox Analysis. 195 patients with ALF and 318 patients with ACLF were included in this study. The primary outcome of interest was 90-day mortality. This study enrolled a total of 513 patients. Of these, 119 patients (61%) with ALF and 140 patients (44%) with ACLF experienced MODS. Patients with ALF exhibited a higher number of organ failures compared to those with ACLF (2 vs. 1, P = 0.006). Additionally, patients with ALF demonstrated higher median admission critical illness scores.Multivariate logistic analysis indicated that GIB (OR = 3.112, 95% CI 1.4–6.916, P = 0.005), MELD-Na scores (OR = 1.079, 95% CI 1.033–1.127, P = 0.001), Age (OR = 1.056, 95% CI 1.025–1.088, P < 0.001), NLR (OR = 1.073, 95% CI 1.014–1.132, P = 0.014), ICU admission (OR = 4.319, 95% CI 1.347–13.851, P = 0.014), and Clif-SOFA (OR = 1.147, 95% CI 1.022–1.287, P = 0.02) were independent influential factors in predicting 90-day mortality, with an AUCROC of 0.881. Multivariate logistic analysis revealed that SOFA score (OR = 1.255, 95% CI 1.166–1.351, P = 0.001), GCS scores (OR = 0.674, 95% CI 0.606–0.881, P = 0.001), Age (OR = 1.048, 95% CI 1.022–1.076, P < 0.001), and ICU admission (OR = 0.258, 95% CI 0.075–0.885, P = 0.031) were independent influential factors in predicting 90-day mortality, with an AUCROC of 0.872.Cox analysis for cumulative 90-day mortality indicated that patients with ALF had higher mortality rates compared to those with ACLF (33.8% vs. 27%, P = 0.026) and compared to patients with cirrhosis ACLF and non-cirrhosis ACLF (33.8% vs. 31% vs. 25.9%, P = 0.018).Patients with ALF exhibited a higher incidence of MODS and consequently had a poorer 90-day prognosis.