Predictors of acute-on-chronic liver failure (ACLF) and mortality in ambulatory cirrhotic patients

Abstract

Abstract Background Acute-on-chronic liver failure (ACLF) is life-threatening complication of cirrhosis. ACLF’s prevalence and outcomes have been described in hospitalized patients with cirrhosis. However, no data is available on the prevalence and predictors of ACLF in ambulatory cirrhotic patients. Aims Assessment of the incidence and predictors of ACLF in cirrhotic ambulatory patients. Methods A retrospective study of 202 ambulatory patients with cirrhosis was evaluated in a tertiary hospital at the Galilee Medical Center from Feb. 2015 to Dec. 2022 and followed for eight years. Data on developing hepatic and extrahepatic organ failures were collected. ACLF was defined and graded according to the European Association for the Study of Liver-Chronic Liver Failure (EASL-CLIF) Consortium definition. Results Ambulatory with cirrhosis developed ACLF in 37% of cases (74 patients). The mortality rate was significantly high in the ACLF group as compared to the non-ACLF group (38% VS 8.5%, respectively P < 0.001). Patients with ACLF were older, had increased CRP, NLR and WBC, increased LFTS and kidney function, MELD, Child-Pugh, CLIF-C and PADUA scores. Univariate regression showed that MELD score was the most powerful predictor of organ failure. Multivariate analysis showed that MELD and CLIF-C scores were associated with organ failure and developing ACLF (OR 4.5, P < 0.001, OR 3.2, P < 0.001, respectively). Discriminant analysis showed that BUN, MELD, CLIF-C and PADUA scores predicted mortality with 87% accuracy. Conclusion Outpatients with cirrhosis developed ACLF in 40% of cases. MELD and CLIF-C scores are the best ACLF development predictors. PADUA, CLIF-C and MELD scores are the best predictors of mortality. Therefore, we should use MELD, PADUA and CLIF-C scores to evaluate and follow up cirrhotic outpatients in liver units.