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

doi:10.1016/j.dld.2019.04.008

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

Immunology and Immunotherapy

Research output: Contribution to journal › Article › peer-review

2 Citations (Scopus)

367 Downloads (Pure)

Abstract

Background

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.

Methods

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.

Results

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.

Conclusion

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 language	English
Pages (from-to)	1416-1422
Number of pages	7
Journal	Digestive and Liver Disease
Volume	51
Issue number	10
Early online date	4 May 2019
DOIs	https://doi.org/10.1016/j.dld.2019.04.008
Publication status	Published - Oct 2019

Keywords

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

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da_Silva_Boteon_et_al_Predictive_factors_for_28-day_mortality_Digestive_and_Liver_Disease_2019
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Cite this

da Silva Boteon, A. P. C., Chauhan, A., Boteon, Y. L., Tillakaratne, S., Gunson, B., Elsharkawy, A. M., Ford, A., Bangash, M., Murphy, N., Armstrong, M. J., Rajoriya, N., & Perera, M. T. P. R. (2019). Predictive factors for 28-day mortality in acute-on-chronic liver failure patients admitted to the intensive care unit. Digestive and Liver Disease, 51(10), 1416-1422. https://doi.org/10.1016/j.dld.2019.04.008

@article{adc3ae95d9ec41b79291164d5722bc6e,

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

abstract = "BackgroundAcute-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. MethodsRetrospective 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. ResultsSeventy-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. ConclusionPatients 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.",

keywords = "acute-on-chronic liver failure, intensive care unit, liver transplantation, prognosis",

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

year = "2019",

month = oct,

doi = "10.1016/j.dld.2019.04.008",

language = "English",

volume = "51",

pages = "1416--1422",

journal = "Digestive and Liver Disease",

issn = "1590-8658",

publisher = "Elsevier",

number = "10",

}

da Silva Boteon, APC, Chauhan, A, Boteon, YL, Tillakaratne, S, Gunson, B, Elsharkawy, AM, Ford, A, Bangash, M, Murphy, N, Armstrong, MJ, Rajoriya, N & Perera, MTPR 2019, 'Predictive factors for 28-day mortality in acute-on-chronic liver failure patients admitted to the intensive care unit', Digestive and Liver Disease, vol. 51, no. 10, pp. 1416-1422. https://doi.org/10.1016/j.dld.2019.04.008

TY - JOUR

T1 - Predictive factors for 28-day mortality in acute-on-chronic liver failure patients admitted to the intensive care unit

AU - da Silva Boteon, Amanda Pinter Carvalheiro

AU - Chauhan, Abhishek

AU - Boteon, Yuri Longatto

AU - Tillakaratne, Suchintha

AU - Gunson, Bridget

AU - Elsharkawy, Ahmed Mohamed

AU - Ford, Abby

AU - Bangash, Mansoor

AU - Murphy, Nick

AU - Armstrong, Matthew J

AU - Rajoriya, Neil

AU - Perera, M Thamara P R

PY - 2019/10

Y1 - 2019/10

N2 - BackgroundAcute-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. MethodsRetrospective 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. ResultsSeventy-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. ConclusionPatients 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.

AB - BackgroundAcute-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. MethodsRetrospective 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. ResultsSeventy-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. ConclusionPatients 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.

KW - acute-on-chronic liver failure

KW - intensive care unit

KW - liver transplantation

KW - prognosis

U2 - 10.1016/j.dld.2019.04.008

DO - 10.1016/j.dld.2019.04.008

M3 - Article

C2 - 31064706

SN - 1590-8658

VL - 51

SP - 1416

EP - 1422

JO - Digestive and Liver Disease

JF - Digestive and Liver Disease

IS - 10

ER -

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

Abstract

Keywords

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