Kafle Pradip Kumar, Jha Anurag, Kafle Bhandari Brindeswari, Hamal Rabin, Sherpa Tshering W, Koirala Dinesh, Bhattarai Tulsiram, Lamsal Manoj, Parajuli Sushil, Pathak Rahul
Gastroenterology, Tribhuvan University Institute of Medicine, Kathmandu, NPL.
Medicine, Kathmandu Medical College and Teaching Hospital, Kathmandu, NPL.
Cureus. 2025 Jun 20;17(6):e86468. doi: 10.7759/cureus.86468. eCollection 2025 Jun.
Background and aim Acute-on-chronic liver failure (ACLF) is a dynamic condition with very high short-term mortality. Although several mortality predictors have been studied, no single factor can reliably predict its course and outcome. This study aimed to evaluate various biochemical parameters and severity scores at presentation to assess their ability to predict mortality in ACLF patients. Methods An observational cross-sectional study was conducted from March 2024 to February 2025 at a tertiary care center in Nepal. A total of 51 patients were enrolled over one year. ACLF was diagnosed based on the Asia-Pacific Association for the Study of the Liver (APASL) criteria and/or the European Association for the Study of the Liver-Chronic Liver Failure Consortium (EASL-CLIF) criteria. Clinical features, biochemical parameters, and severity scores at admission were analyzed. Results The overall mortality rate was high (56.9%), consistent with previous studies. About 28% of patients who met the APASL definition of ACLF did not fulfill the EASL-CLIF criteria. On univariate analysis, factors such as oliguria, hepatic encephalopathy (HE) grade, ACLF grade, total serum protein, urea, ascitic fluid total leukocyte count, serum lactate, and APASL-ACLF Research Consortium (AARC) score were associated with mortality. However, multivariate analysis did not identify a single independent predictor of mortality. Different scoring systems were useful in predicting mortality at admission. Among them, the CLIF-C ACLF score had the highest predictive accuracy (area under the curve (AUC): 0.990), followed by the AARC score (AUC: 0.79), Sequential Organ Failure Assessment (SOFA) score, and Model for End-Stage Liver Disease (MELD) score. However, the Child-Turcotte-Pugh (CTP) score at admission was not effective in predicting mortality. Conclusion ACLF represents an acute flare of inflammation on a background of chronic liver disease. Using multiple mortality predictors at the time of admission can help guide treatment decisions and provide better prognostication of patient outcomes.
背景与目的 慢加急性肝衰竭（ACLF）是一种动态疾病，短期死亡率极高。尽管已经对多种死亡率预测指标进行了研究，但没有单一因素能够可靠地预测其病程和结局。本研究旨在评估患者就诊时的各种生化参数和严重程度评分，以评估它们预测ACLF患者死亡率的能力。方法 2024年3月至2025年2月在尼泊尔的一家三级医疗中心进行了一项观察性横断面研究。一年中共纳入51例患者。根据亚太肝脏研究协会（APASL）标准和/或欧洲肝脏研究协会 - 慢性肝衰竭联盟（EASL - CLIF）标准诊断ACLF。分析了入院时的临床特征、生化参数和严重程度评分。结果 总体死亡率较高（56.9%），与先前研究一致。约28%符合APASL定义的ACLF患者未满足EASL - CLIF标准。单因素分析显示，少尿、肝性脑病（HE）分级、ACLF分级、血清总蛋白、尿素、腹水总白细胞计数、血清乳酸和APASL - ACLF研究联盟（AARC）评分等因素与死亡率相关。然而，多因素分析未确定单一的独立死亡率预测指标。不同的评分系统在预测入院时的死亡率方面有用。其中，CLIF - C ACLF评分的预测准确性最高（曲线下面积（AUC）：0.990），其次是AARC评分（AUC：0.79）、序贯器官衰竭评估（SOFA）评分和终末期肝病模型（MELD）评分。然而，入院时的Child - Turcotte - Pugh（CTP）评分在预测死亡率方面无效。结论 ACLF代表慢性肝病背景下的急性炎症发作。入院时使用多种死亡率预测指标有助于指导治疗决策并更好地预测患者预后。
