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Short-Term Mortality of Acute-on-Chronic Liver Failure

J Hepatol; ePub 2018 Dec 24; Hernaez, et al

In a US cohort of hospitalized patients with decompressed cirrhosis, acute-on-chronic liver failure (ACLF) is was common and associated with high short-term mortality. Researchers used the US Department of Veterans Affairs (VA) Corporate Data Warehouse to identify patients with ACLF during hospitalization for decompensated cirrhosis at any of the 127 VA hospitals between 2004 and 2014. The prevalence of ACLF and variables associated with 28- and 90-day mortality in ACLF were examined, along with trends in prevalence and survival over time. Among the findings:

  • Of 72,316 racially/ethnically diverse patients hospitalized for decompensated cirrhosis, 19,082 (26.4%) patients me the criteria of ACLF on admission.
  • Patients with ACLF had high 28- and 90-day mortality (25.5% and 40.02%, respectively).
  • Mortality risk increased in parallel with the number of organ failure and ranged from 17% to 53% at 28 days and from 31% to 69% at 90 days.
  • African American race and being seen at a transplant center were associated with lower risk of ACLF mortality.


Hernaez R, Kramer JR, Liu Y, et al. Prevalence and short-term mortality of acute-on-chronic liver failure: A national cohort study from the USA. [Published online ahead of print December 24, 2018]. J Hepatol. doi:10.1016/j.jhep.2018.12.018.