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

Research output: Contribution to journalArticlepeer-review


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

Colleges, School and Institutes

External organisations

  • University Hospitals Birmingham NHS Foundation Trust



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