Prevalence and risk factors of acute-on-chronic liver failure in a single center from Argentina

Table 1 Chronic liver failure-sequential organ failure assessment score

Organ/system	0	1	2	3	4
Liver (bilirubin, mg/dL)	< 1.2	≥ 1.2 to ≤ 2	≥ 2 to < 6	≥ 6 to < 12	≥ 12
Kidney (creatinine, mg/dL)	< 1.2	≥ 1.2 to < 2	≥ 2 to < 3.5	≥ 3.5 to < 5 or dialysis	≥ 5 or diálysis
Cerebral (HE grade)	No HE	I	II	III	IV
Coagulation (RIN, platelet count)	< 1.1	≥ 1.1 to < 1.25	≥ 1.25 to < 1.5	≥ 1.5 to < 2.5	≥ 2.5 or platelet count ≤ 20000 per cubic millimeter
Circulation (mean arterial pressure, mmHg), inotropic drugs (μg/kg per minute)	≥ 70	< 70	Dopamine ≤ 5 or dobutamine or terlipressin	Dopamine > 5 or E ≤ 0.1 or NE ≤ 0.1	Dopamine > 15 or E > 0.1 or NE > 0.1
Lungs (SpO2/FiO2)	> 512	> 357 a ≤ 512	> 214 a ≤ 357	> 89 to ≤ 214	≤ 89

The text in bold indicates the diagnostic criteria for organ failure. HE: Hepatic encephalopathy; E: Epinephrine; NE: Norepinephrine; FiO₂: Fraction of inspired oxygen; SpO₂: Pulse oximetric saturation.

Table 2 Cirrhosis etiology

Etiology	n (%)
Alcohol	58 (58)
Alcohol + hepatitis C virus	5 (5)
Hepatitis C virus	13 (13)
Nonalcoholic steatohepatitis	4 (4)
Cryptogenic	12 (12)
Autoimmune hepatitis	4 (4)
Primary biliary cirrosis	1 (1)
Primary biliary cirrhosis + autoimmune hepatitis	1 (1)
Hepatitis B virus + alcohol	1 (1)
Hemochromatosis	1 (1)

Table 3 Prevalence of acute on chronic liver failure n (%)

ACLF	Grade 1	Grade 2	Grade 3
Patients	10 (34.4)	5 (17.3)	14 (48.3)
Mortality	3 (30)	2 (40)	13 (92)

ACLF: Acute-on-chronic liver failure.

Table 4 Type and number of organ failure n (%)

Organs failure	ACLF 1	ACLF 2	ACLF 3
Renal	7 (70)	2 (40)	10 (71)
Cerebral	1 (10)	1 (20)	12 (85)
Coagulation	1 (10)	3 (60)	8 (57)
Liver	1 (10)	1 (20)	2 (14)
Circulatory	0 (0)	1 (20)	14 (100)
Respiratory	1 (10)	2 (40)	14 (100)

ACLF: Acute-on-chronic liver failure.

Table 5 Precipitating events of acute-on-chronic liver failure

Potential precipitating events of ACLF	n (%)
Bacterial infection	12 (41.3)
Gastrointestinal hemorrhage	8 (27.5)
Renal failure secondary to acute diarrhea	1 (3.4)
No precipitating event	8 (27.5)

ACLF: Acute-on-chronic liver failure.

Table 6 Comparative results between groups with and without acute on chronic liver failure n (%)

	ACLF	No ACLF	P vaule	OR	95%CI
Age (yr ± SD)	60 ± 11	60 ± 11	1.00
Male	23 (79)	44 (62)	0.11	2.3	0.78-7.43
Child Pugh (score ± DS)	10.2 ± 2.1	8.4 ± 1.6	< 0.0001
MELD (score ± DS)	20.7 ± 8.5	12.3 ± 4	< 0.0001
Active alcoholism	9 (31)	22 (31)	1.00	1	0.3-2.8
Prior ascites	18 (62)	29 (41)	0.07	2.3	0.9-6.3
Prior encephalopthy, n (%)	9 (31)	10 (14)	0.08	2.74	0.9-8.7
Esophageal varices	18 (62)	37 (52)	0.38	1.5	0.5-4
Ascites	27 (93)	43 (60.5)	0.001	8.8	1.8-58.1
Variceal hemorrhage	4 (13.7)	10 (14)	1	0.97	0.2-3.8
White cell count (n/mm3± SD)	15.300 ± 10.770	8.033 ± 5.601	< 0.0001
Serum sodium (mEq/L ± SD)	133.3 ± 6.9	135.1 ± 5.3	0.16
CRP (mg/L ± SD)	50.9 ± 46.4	28.6 ± 23.4	0.002
Mortality	18 (62)	4 (5.6)	< 0.0001

OR: Odds ratio; 95%CI: Confidence interval 95%; SD: Standard deviation; CRP: C-reactive protein; ACLF: Acute-on-chronic liver failure.