Research Article
Volume 8 Issue 2 - 2021
Prevalence and Predictors of Acute on Chronic Liver Failure in Cirrhotic Patients Hospitalized for Acute Decompensation
Trad Nouha*, Ghanem Mohamed, Ben Slimen Baha, Boughoula Khouloud, Bizid Sondes, Ben Abdallah Hatem, Bouali Riadh and Abdelli Mohamed Nabil
Department of Gastroenterology, Military Hospital of Tunis, Faculty of Medicine of Tunis, Tunis, Tunisia
*Corresponding Author: Trad Nouha, Department of Gastroenterology, Military Hospital of Tunis, Faculty of Medicine of Tunis, Tunis, Tunisia.
Received: November 26, 2020; Published: January 20, 2021




Abstract

Background: Acute on chronic liver failure (ACLF) is associated with organ failures and high short-term mortality. Our objective was to determine the prevalence and the predictors of ACLF in cirrhotic patients hospitalized for acute decompensation.

Methods: Consecutive cirrhotic patients hospitalized for acute decompensation were recruited from January 2012 to December 2019. Logistic regression analyses were performed to identify clinical and epidemiological predictors of ACLF.

Results: In total, 195 patients were included. The mean age was 65.4 ± 13.1 years and the sex-ratio was 1.7. During follow-up, these patients were admitted to our department 460 times. ACLF occurred in 28.6% of admissions. Grade 1 was the most common (55.3%) followed by Grade 2 (22.7%) and Grade 3 (21.9%). The predictors of ACLF occurrence in our series were: bacterial infection (p < 0.001), CHILD-pugh score (p = 0.001), high MELD score on admission (p = 0,001), advanced age > 50 years (p = 0,02) and history of high blood pressure (p = 0,04). In multivariate analysis, only bacterial infection (p < 0.001, OR = 23.6), CHILD-pugh score (p = 0.02, OR = 20.3) MELD-Na and MELD score (p = 0.003, OR = 10.2) were independent predictors of ACLF.

Conclusion: In our study, the prevalence of ACLF was 28.6% of admissions. As a major precipitating factor, Bacterial infections would require rapid and effective management as well as close monitoring.

Keywords: Liver Cirrhosis; ACLF; Bacterial Infection; Prevalence; Predictors

References

    1. Moreau R. “Acute-on-chronic liver failure: a new syndrome in cirrhosis”. Clinical and Molecular Hepatology 22.1 (2016): 1‑6. 2. Fernández J., et al. “Bacterial and fungal infections in acute-on-chronic liver failure: prevalence, characteristics and impact on prognosis”. Gut 67.10 (2018): 1870‑1880. 3. Moreau R., et al. “Acute-on-Chronic Liver Failure Is a Distinct Syndrome That Develops in Patients With Acute Decompensation of Cirrhosis”. Gastroenterology 144.7 (2013): 1426-1437. 4. Li H., et al. “Characteristics, Diagnosis and Prognosis of Acute-on-Chronic Liver Failure in Cirrhosis Associated to Hepatitis B”. Scientific Reports (2016). 5. Hernaez R., et al. “Prevalence and short-term mortality of acute-on-chronic liver failure: A national cohort study from the USA”. Journal of Hepatology 70.4 (2019): 639‑647. 6. Arroyo V., et al. “Acute-on-chronic liver failure in cirrhosis”. Nature Reviews Disease Primers 2 (2016): 16041. 7. Angeli P., et al. “EASL Clinical Practice Guidelines for the management of patients with decompensated cirrhosis”. Journal of Hepatology 69.2 (2018): 406‑460. 8. Na SH., et al. “Comparison of clinical characteristics and outcomes of spontaneous bacterial peritonitis and culture negative neutrocytic ascites”. Scandinavian Journal of Gastroenterology 52.2 (2017): 199‑203. 9. Fernández J., et al. “Clinical course and short-term mortality of cirrhotic patients with infections other than spontaneous bacterial peritonitis”. Liver International 37.3 (2017): 385‑395. 10. Salerno F., et al. “The impact of infection by multidrug-resistant agents in patients with cirrhosis. A multicenter prospective study”. Liver International 37.1 (2017): 71‑79. 11. Bennett JE., et al. “Mandell, Douglas, and Bennett’s infectious disease essentials”. Philadelphia, PA: Elsevier (2017). 12. Piano S., et al. “Epidemiology and Effects of Bacterial Infections in Patients With Cirrhosis Worldwide”. Gastroenterology 156.5 (2019): 1368-1380. 13. Zhao H., et al. “Community- or Healthcare-Associated Bacterial Infections Increase Long-Term Mortality in Patients With Acute Decompensation of Cirrhosis”. The American Journal of the Medical Sciences 355.2 (2018): 132‑139. 14. Shalimar Rout G., et al. “Prevalence, predictors and impact of bacterial infection in acute on chronic liver failure patients”. Digestive and Liver Disease 50.11 (2018): 1225‑1231. 15. Shi Y., et al. “Acute-on-chronic liver failure precipitated by hepatic injury is distinct from that precipitated by extrahepatic insults”. Hepatology 62.1 (2015): 232‑242. 16. Piano S., et al. “Incidence, predictors and outcomes of acute-on-chronic liver failure in outpatients with cirrhosis”. Journal of Hepatology 67.6 (2017): 1177‑1184. 17. Mücke MM., et al. “Bacterial infection-triggered acute-on-chronic liver failure is associated with increased mortality”. Liver International 38.4 (2018): 645‑653. 18. Cao Z-J., et al. “Bacterial infection triggers and complicates acute-on-chronic liver failure in patients with hepatitis B virus-decompensated cirrhosis: A retrospective cohort study”. World Journal of Gastroenterology 26.6 (2020): 645‑656.
Citation: Trad Nouha., et al. “Prevalence and Predictors of Acute on Chronic Liver Failure in Cirrhotic Patients Hospitalized for Acute Decompensation”. EC Gastroenterology and Digestive System 8.2 (2021): 36-43.

PubMed Indexed Article


EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005


EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777


EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347


EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478


EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253


EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033


EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992


EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505


EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793


EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211


EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047


EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560


EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318


EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819


EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840


EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344


EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476


EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658


EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489


EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278


EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108


EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571


EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333


EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883


EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001


EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937


EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723


EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726


EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603


EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646


EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616


EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290


EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226


EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812


EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268


News and Events


April Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the April issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for upcoming Issue

Ecronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before April 26, 2021.

Certificate of Publication

Ecronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

Ecronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.

Immediate Assistance

The prime motto of this team is to clarify all the queries without any delay or hesitation to avoid the inconvenience. For immediate assistance on your queries please don't hesitate to drop an email to editor@ecronicon.uk