Long-term Prognosis of Acute-on-Chronic Liver Failure Survivors. Issue 2 (February 2019)

• Record Type: Journal Article
• Authors: Yoon, Eileen L.; Kim, Tae Yeob; Lee, Chang Hyeong; Kim, Tae Hun; Cho, Hyun Chin; Lee, Sang Soo; Kim, Sung Eun; Kim, Hee Yeon; Kim, Chang Wook; Song, Do Seon; Yang, Jin Mo; Sinn, Dong Hyun; Jung, Young Kul; Yim, Hyung Joon; Kim, Hyoung Su; Sohn, Joo Hyun; Kim, Jeong Han; Choe, Won Hyeok; Lee, Byung Seok; Kim, Moon Young; Jeong, Soung Won; Choi, Eunhee; Kim, Dong Joon
• Is Part Of: Journal of clinical gastroenterology. Volume 53:Issue 2(2019)
• Publication Date: 2019-02
• Subjects: acute-on-chronic liver failure -- decompensation -- organ failure -- survival; Gastroenterology -- Periodicals; Digestive organs -- Diseases -- Periodicals; Gastroenterology -- Periodicals; Digestive organs -- Diseases; Gastroenterology; Periodicals; Periodicals; 616.33005
• DOI: 10.1097/MCG.0000000000000987
• Languages: English
• ISSNs: 0192-0790

Abstract

Abstract : Goals: We aimed to investigate significant factors influencing the long-term prognosis of patients who survived acute-on-chronic liver failure (ACLF). Background: The mortality of ACLF is predominantly affected by the organ failure severity. However, long-term outcomes of patients who survive ACLF are not known. Study: A cohort of 1084 cirrhotic patients who survived for more than 3 months following acute deterioration of liver function was prospectively followed. ACLF was defined by the European Association for the Study of the Liver Chronic Liver Failure Consortium definition. Results: The mean follow-up duration was 19.4±9.9 months. In the subgroup of patients without previous acute decompensation (AD), ACLF occurrence did not affect long-term outcomes. However, in patients with previous AD, ACLF negatively affected long-term transplant-free survival even after overcoming ACLF (hazard ratio, 2.00, P =0.012). Previous AD was the significant predictive factor of long-term mortality and was independent of the Model for End-stage Liver Disease score in these ACLF-surviving patients. Organ failure severity did not affect transplant-free survival in patients who survived an ACLF episode. Conclusions: A prior history of AD is the most important factor affecting long-term outcomes following an ACLF episode regardless of Model for End-stage Liver Disease score. Prevention of a first AD episode may improve the long-term transplant-free survival of liver cirrhosis patients.