Predictive factors for 28-day mortality in acute-on-chronic liver failure patients admitted to the intensive care unit

Amanda Pinter Carvalheiro da Silva Boteon, Abhishek Chauhan, Yuri Longatto Boteon, Suchintha Tillakaratne, Bridget Gunson, Ahmed Mohamed Elsharkawy, Abby Ford, Mansoor Bangash, Nick Murphy, Matthew J Armstrong, Neil Rajoriya, M Thamara P R Perera

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Acute-on-chronic liver failure (ACLF) is an entity comprising an acute deterioration of liver function in cirrhotic patients, associated with organ failure(s) and high short-term mortality. We aimed to identify predictive factors for short-term mortality in patients admitted with ACLF that may benefit most from liver transplantation.


Retrospective analysis of patients admitted in ACLF to a tertiary intensive care unit between 2013 and 2017 was performed. The EASL-CLIF acute-on-chronic liver failure in cirrhosis (CANONIC) criteria were used to define ACLF grade. Multivariable analysis using 28-day mortality as an end-point was performed, including severity-of-disease scores and clinical parameters.


Seventy-seven patients were admitted in ACLF over the study period. The commonest aetiology of liver disease was alcohol related 52/77(68%) and the commonest precipitant of ACLF was variceal haemorrhage 38/77(49%). Overall 28-day mortality was 42/77(55%) [ACLF-(grade)1:3/42(7%); ACLF-2:10/42(24%); and, ACLF-3:29/42(69%);p = 0.002]. On multivariable analysis MELD ≥ 26 [odds ratio(OR) = 11.559; 95% confidence interval(CI):2.820–47.382;p = 0.001], ACLF-3 (OR = 3.287; 95%CI:1.047–10.325;p = 0.042) at admission and requirement for renal replacement therapy (OR = 5.348; 95%CI:1.385–20.645;p = 0.015) were independently associated with 28-day mortality.


Patients admitted with ACLF to intensive care have a high mortality rate. Defined early thresholds at admission can identify patients at the highest risk that may benefit most from liver transplantation.

Original languageEnglish
Pages (from-to)1416-1422
Number of pages7
JournalDigestive and Liver Disease
Issue number10
Early online date4 May 2019
Publication statusPublished - Oct 2019


  • acute-on-chronic liver failure
  • intensive care unit
  • liver transplantation
  • prognosis


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