Characteristics and discrepancies in acute-on-chronic liver failure: Need for a unified definition

Tae Yeob Kim, Do Seon Song, Hee Yeon Kim, Dong Hyun Sinn, Eileen L. Yoon, Chang Wook Kim, Young Kul Jung, Ki Tae Suk, Sang Soo Lee, Chang Hyeong Lee, Tae Hun Kim, Jeong Han Kim, Won Hyeok Choe, Hyung Joon Yim, Sung Eun Kim, Soon Koo Baik, Byung Seok Lee, Jae Young Jang, Jeong Ill Suh, Hyoung Su KimSeong Woo Nam, Hyeok Choon Kwon, Young Seok Kim, Sang Gyune Kim, Hee Bok Chae, Jin Mo Yang, Joo Hyun Sohn, Heon Ju Lee, Seung Ha Park, Byung Hoon Han, Eun Hee Choi, Chang H. Kim, Dong Joon Kim

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

Background & Aim To investigate the prevalence, mortalities, and patient characteristics of Acute-on-chronic liver failure (ACLF) according to the AARC (Asian Pacific Association for the Study of the Methods We collected retrospective data for 1470 hospitalized patients with chronic liver disease (CLD) and acute deterioration between January 2013 and December 2013 from 21 university hospitals in Korea. Results Of the patients assessed, the prevalence of ACLF based on the AARC and CLIF-C definitions was 9.5% and 18.6%, respectively. The 28-day and 90-day mortality rates were higher in patients with ACLF than in those without ACLF. Patients who only met the CLIF-C definition had significantly lower 28-day and 90-day survival rates than those who only met the AARC definition (68.0% vs. 93.9%, P<0.001; 55.1%vs. 92.4%, P<0.001). Among the patients who had non-cirrhotic CLD, the 90-day mortality of the patients with ACLF was higher than of those without ACLF, although not significant (33.3% vs. 6.0%, P = 0.192). Patients with previous acute decompensation (AD) within 1- year had a lower 90-day survival rate than those with AD more than 1 year prior or without previous AD (81.0% vs. 91.9% or 89.4%, respectively, all P<0.001). Patients who had extra-hepatic organ failure without liver failure had a similar 90-day survival rate to those who had liver failure as a prerequisite (57.0% vs. 60.6%, P = 0.391). Conclusions The two ACLF definitions result in differences in mortality and patient characteristics among ACLF patients. We suggest that non-cirrhotic CLD, previous AD within 1 year, and extrahepatic organ failure should be included in the ACLF diagnostic criteria. In addition, further studies are necessary to develop a universal definition of ACLF.

Original languageEnglish
Article numbere0146745
JournalPloS one
Volume11
Issue number1
DOIs
Publication statusPublished - 2016 Jan 1

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liver failure
Liver
Liver Failure
liver diseases
Liver Diseases
Chronic Disease
Survival Rate
Mortality
survival rate
Acute-On-Chronic Liver Failure
Korea
Korean Peninsula

All Science Journal Classification (ASJC) codes

  • Biochemistry, Genetics and Molecular Biology(all)
  • Agricultural and Biological Sciences(all)
  • General

Cite this

Kim, T. Y., Song, D. S., Kim, H. Y., Sinn, D. H., Yoon, E. L., Kim, C. W., ... Kim, D. J. (2016). Characteristics and discrepancies in acute-on-chronic liver failure: Need for a unified definition. PloS one, 11(1), [e0146745]. https://doi.org/10.1371/journal.pone.0146745
Kim, Tae Yeob ; Song, Do Seon ; Kim, Hee Yeon ; Sinn, Dong Hyun ; Yoon, Eileen L. ; Kim, Chang Wook ; Jung, Young Kul ; Suk, Ki Tae ; Lee, Sang Soo ; Lee, Chang Hyeong ; Kim, Tae Hun ; Kim, Jeong Han ; Choe, Won Hyeok ; Yim, Hyung Joon ; Kim, Sung Eun ; Baik, Soon Koo ; Lee, Byung Seok ; Jang, Jae Young ; Suh, Jeong Ill ; Kim, Hyoung Su ; Nam, Seong Woo ; Kwon, Hyeok Choon ; Kim, Young Seok ; Kim, Sang Gyune ; Chae, Hee Bok ; Yang, Jin Mo ; Sohn, Joo Hyun ; Lee, Heon Ju ; Park, Seung Ha ; Han, Byung Hoon ; Choi, Eun Hee ; Kim, Chang H. ; Kim, Dong Joon. / Characteristics and discrepancies in acute-on-chronic liver failure : Need for a unified definition. In: PloS one. 2016 ; Vol. 11, No. 1.
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title = "Characteristics and discrepancies in acute-on-chronic liver failure: Need for a unified definition",
abstract = "Background & Aim To investigate the prevalence, mortalities, and patient characteristics of Acute-on-chronic liver failure (ACLF) according to the AARC (Asian Pacific Association for the Study of the Methods We collected retrospective data for 1470 hospitalized patients with chronic liver disease (CLD) and acute deterioration between January 2013 and December 2013 from 21 university hospitals in Korea. Results Of the patients assessed, the prevalence of ACLF based on the AARC and CLIF-C definitions was 9.5{\%} and 18.6{\%}, respectively. The 28-day and 90-day mortality rates were higher in patients with ACLF than in those without ACLF. Patients who only met the CLIF-C definition had significantly lower 28-day and 90-day survival rates than those who only met the AARC definition (68.0{\%} vs. 93.9{\%}, P<0.001; 55.1{\%}vs. 92.4{\%}, P<0.001). Among the patients who had non-cirrhotic CLD, the 90-day mortality of the patients with ACLF was higher than of those without ACLF, although not significant (33.3{\%} vs. 6.0{\%}, P = 0.192). Patients with previous acute decompensation (AD) within 1- year had a lower 90-day survival rate than those with AD more than 1 year prior or without previous AD (81.0{\%} vs. 91.9{\%} or 89.4{\%}, respectively, all P<0.001). Patients who had extra-hepatic organ failure without liver failure had a similar 90-day survival rate to those who had liver failure as a prerequisite (57.0{\%} vs. 60.6{\%}, P = 0.391). Conclusions The two ACLF definitions result in differences in mortality and patient characteristics among ACLF patients. We suggest that non-cirrhotic CLD, previous AD within 1 year, and extrahepatic organ failure should be included in the ACLF diagnostic criteria. In addition, further studies are necessary to develop a universal definition of ACLF.",
author = "Kim, {Tae Yeob} and Song, {Do Seon} and Kim, {Hee Yeon} and Sinn, {Dong Hyun} and Yoon, {Eileen L.} and Kim, {Chang Wook} and Jung, {Young Kul} and Suk, {Ki Tae} and Lee, {Sang Soo} and Lee, {Chang Hyeong} and Kim, {Tae Hun} and Kim, {Jeong Han} and Choe, {Won Hyeok} and Yim, {Hyung Joon} and Kim, {Sung Eun} and Baik, {Soon Koo} and Lee, {Byung Seok} and Jang, {Jae Young} and Suh, {Jeong Ill} and Kim, {Hyoung Su} and Nam, {Seong Woo} and Kwon, {Hyeok Choon} and Kim, {Young Seok} and Kim, {Sang Gyune} and Chae, {Hee Bok} and Yang, {Jin Mo} and Sohn, {Joo Hyun} and Lee, {Heon Ju} and Park, {Seung Ha} and Han, {Byung Hoon} and Choi, {Eun Hee} and Kim, {Chang H.} and Kim, {Dong Joon}",
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language = "English",
volume = "11",
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Kim, TY, Song, DS, Kim, HY, Sinn, DH, Yoon, EL, Kim, CW, Jung, YK, Suk, KT, Lee, SS, Lee, CH, Kim, TH, Kim, JH, Choe, WH, Yim, HJ, Kim, SE, Baik, SK, Lee, BS, Jang, JY, Suh, JI, Kim, HS, Nam, SW, Kwon, HC, Kim, YS, Kim, SG, Chae, HB, Yang, JM, Sohn, JH, Lee, HJ, Park, SH, Han, BH, Choi, EH, Kim, CH & Kim, DJ 2016, 'Characteristics and discrepancies in acute-on-chronic liver failure: Need for a unified definition', PloS one, vol. 11, no. 1, e0146745. https://doi.org/10.1371/journal.pone.0146745

Characteristics and discrepancies in acute-on-chronic liver failure : Need for a unified definition. / Kim, Tae Yeob; Song, Do Seon; Kim, Hee Yeon; Sinn, Dong Hyun; Yoon, Eileen L.; Kim, Chang Wook; Jung, Young Kul; Suk, Ki Tae; Lee, Sang Soo; Lee, Chang Hyeong; Kim, Tae Hun; Kim, Jeong Han; Choe, Won Hyeok; Yim, Hyung Joon; Kim, Sung Eun; Baik, Soon Koo; Lee, Byung Seok; Jang, Jae Young; Suh, Jeong Ill; Kim, Hyoung Su; Nam, Seong Woo; Kwon, Hyeok Choon; Kim, Young Seok; Kim, Sang Gyune; Chae, Hee Bok; Yang, Jin Mo; Sohn, Joo Hyun; Lee, Heon Ju; Park, Seung Ha; Han, Byung Hoon; Choi, Eun Hee; Kim, Chang H.; Kim, Dong Joon.

In: PloS one, Vol. 11, No. 1, e0146745, 01.01.2016.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Characteristics and discrepancies in acute-on-chronic liver failure

T2 - Need for a unified definition

AU - Kim, Tae Yeob

AU - Song, Do Seon

AU - Kim, Hee Yeon

AU - Sinn, Dong Hyun

AU - Yoon, Eileen L.

AU - Kim, Chang Wook

AU - Jung, Young Kul

AU - Suk, Ki Tae

AU - Lee, Sang Soo

AU - Lee, Chang Hyeong

AU - Kim, Tae Hun

AU - Kim, Jeong Han

AU - Choe, Won Hyeok

AU - Yim, Hyung Joon

AU - Kim, Sung Eun

AU - Baik, Soon Koo

AU - Lee, Byung Seok

AU - Jang, Jae Young

AU - Suh, Jeong Ill

AU - Kim, Hyoung Su

AU - Nam, Seong Woo

AU - Kwon, Hyeok Choon

AU - Kim, Young Seok

AU - Kim, Sang Gyune

AU - Chae, Hee Bok

AU - Yang, Jin Mo

AU - Sohn, Joo Hyun

AU - Lee, Heon Ju

AU - Park, Seung Ha

AU - Han, Byung Hoon

AU - Choi, Eun Hee

AU - Kim, Chang H.

AU - Kim, Dong Joon

PY - 2016/1/1

Y1 - 2016/1/1

N2 - Background & Aim To investigate the prevalence, mortalities, and patient characteristics of Acute-on-chronic liver failure (ACLF) according to the AARC (Asian Pacific Association for the Study of the Methods We collected retrospective data for 1470 hospitalized patients with chronic liver disease (CLD) and acute deterioration between January 2013 and December 2013 from 21 university hospitals in Korea. Results Of the patients assessed, the prevalence of ACLF based on the AARC and CLIF-C definitions was 9.5% and 18.6%, respectively. The 28-day and 90-day mortality rates were higher in patients with ACLF than in those without ACLF. Patients who only met the CLIF-C definition had significantly lower 28-day and 90-day survival rates than those who only met the AARC definition (68.0% vs. 93.9%, P<0.001; 55.1%vs. 92.4%, P<0.001). Among the patients who had non-cirrhotic CLD, the 90-day mortality of the patients with ACLF was higher than of those without ACLF, although not significant (33.3% vs. 6.0%, P = 0.192). Patients with previous acute decompensation (AD) within 1- year had a lower 90-day survival rate than those with AD more than 1 year prior or without previous AD (81.0% vs. 91.9% or 89.4%, respectively, all P<0.001). Patients who had extra-hepatic organ failure without liver failure had a similar 90-day survival rate to those who had liver failure as a prerequisite (57.0% vs. 60.6%, P = 0.391). Conclusions The two ACLF definitions result in differences in mortality and patient characteristics among ACLF patients. We suggest that non-cirrhotic CLD, previous AD within 1 year, and extrahepatic organ failure should be included in the ACLF diagnostic criteria. In addition, further studies are necessary to develop a universal definition of ACLF.

AB - Background & Aim To investigate the prevalence, mortalities, and patient characteristics of Acute-on-chronic liver failure (ACLF) according to the AARC (Asian Pacific Association for the Study of the Methods We collected retrospective data for 1470 hospitalized patients with chronic liver disease (CLD) and acute deterioration between January 2013 and December 2013 from 21 university hospitals in Korea. Results Of the patients assessed, the prevalence of ACLF based on the AARC and CLIF-C definitions was 9.5% and 18.6%, respectively. The 28-day and 90-day mortality rates were higher in patients with ACLF than in those without ACLF. Patients who only met the CLIF-C definition had significantly lower 28-day and 90-day survival rates than those who only met the AARC definition (68.0% vs. 93.9%, P<0.001; 55.1%vs. 92.4%, P<0.001). Among the patients who had non-cirrhotic CLD, the 90-day mortality of the patients with ACLF was higher than of those without ACLF, although not significant (33.3% vs. 6.0%, P = 0.192). Patients with previous acute decompensation (AD) within 1- year had a lower 90-day survival rate than those with AD more than 1 year prior or without previous AD (81.0% vs. 91.9% or 89.4%, respectively, all P<0.001). Patients who had extra-hepatic organ failure without liver failure had a similar 90-day survival rate to those who had liver failure as a prerequisite (57.0% vs. 60.6%, P = 0.391). Conclusions The two ACLF definitions result in differences in mortality and patient characteristics among ACLF patients. We suggest that non-cirrhotic CLD, previous AD within 1 year, and extrahepatic organ failure should be included in the ACLF diagnostic criteria. In addition, further studies are necessary to develop a universal definition of ACLF.

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