OP-5 ACUTE-ON-CHRONIC LIVER FAILURE (ACLF) CRITERIA IN ALCOHOL-ASSOCIATED HEPATITIS: IMPLICATIONS FOR LIVER TRANSPLANTATION

No Background: Severe alcohol-associated hepatitis (AH) is considered a common precipitant of acute-on-chronic liver failure (ACLF). This study aims to characterize the association between AH and ACLF, focusing on mortality across different ACLF grades. Multicenter prospective cohort study. We included patients admitted with severe AH between 2015–2022. The main outcome was mortality by ACLF grade during admission. The analysis included survival analysis using Cox regression. We adjusted multivariable models based on the main predictors of mortality observed in prior studies. We prospectively included 646 patients from 24 centers and 8 countries. Age 49.9±11.7 years, 85.1% of men and 64.4% had a previous diagnosis of cirrhosis. Median MELD at admission was 25 [20-31] points, 46.5% of patients were treated with corticosteroids, and only 2.2% underwent liver transplantation (LT). Around 67.4% of patients fulfilled ACLF criteria: 10.1% grade 1, 19.2% grade 2, and 38.1% grade 3. The most frequent organ dysfunctions were 76.2% liver, 40.8% brain, 43.2% coagulation, 29.6% renal, 29.4% circulatory, and 18.9% lung failure. Survival at 180 days was 77.8% (95%CI: 72.1-82.6%) in those without ACLF grade 3 and 28.0% (95%CI: 20.5–36.0%) in those with ACLF grade 3 (p<0.001). In the multivariable model adjusted by age, body mass index, and MELD score, individuals with ACLF grade 3 had lower survival than those without ACLF (HR 2.67, 95%CI: 1.50–4.76; p=0.001). However, those with ACLF grade 1 (HR 1.50, 95%CI: 0.76–2.96; p=0.243) and grade 2 (HR 0.70, 95%CI: 0.31–1.56; p=0.380) were not associated with a higher mortality than those without ACLF. Among patients with AH, only ACLF grade 3 is a major determinant of morbimortality. Thus, patients who fulfill ACLF grade 3 should promptly be referred for early LT. The redefinition of ACLF in AH is essential for better quantifying the severity and determining therapeutic goals.

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Journal
Annals of Hepatology
Published
2024-12-01
DOI
https://doi.org/10.1016/j.aohep.2024.101603
Primary Topic
Liver Disease Diagnosis and Treatment
Type
article
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article

OP-5 ACUTE-ON-CHRONIC LIVER FAILURE (ACLF) CRITERIA IN ALCOHOL-ASSOCIATED HEPATITIS: IMPLICATIONS FOR LIVER TRANSPLANTATION

A. Servín-Caamaño, Scherezada Mejía Loza, Katherine Maldonado, Patrick S. Kamath et al.
Annals of Hepatology
Liver Disease Diagnosis and Treatment
article

OP-5 ACUTE-ON-CHRONIC LIVER FAILURE (ACLF) CRITERIA IN ALCOHOL-ASSOCIATED HEPATITIS: IMPLICATIONS FOR LIVER TRANSPLANTATION

A. Servín-Caamaño, Scherezada Mejía Loza, Katherine Maldonado, Patrick S. Kamath, Enrique V. Carrera, Juan Pablo Roblero, Melisa Dirchwolf, Jorge Arnold, Billy Dunn, Sandra Sánchez, Juan Carlos Restrepo, Fernando Bessone, Raúl Lazarte, Ramon A. Bataller, Manuel Mendizábal, Gonzalo Gómez Perdiguero, Mario Tanno, Francisco Javier Idalsoaga, Jacqueline Córdova, Fátima Higuera-de la Tijera, J. Varela, Juan Pablo Arab, Eduardo Fuentes–López, Cláudia Alves Couto, Marco A. Arrese, Patricia Guerra Salazar, Sebastián Marciano, Mayur Brahmania, Blanca Norero, Daniela Simian, Paula Huerta, Geraldine Ramos, Pedro Montes, Vijay Shah, Rodrigo Escarate, Gustavo Pereira, Roberta Chaves Araújo, Gustavo Ayares, María Ayala-Valverde, José Antonio Velarde, R.H.A. Farias, Bastián Alcayaga, Rita Silva, Jaime Gómez, Gustavo Romero, Diego Pérez, Ashwani K. Singal, Cristina Melo Rocha, Luis Antonio Diaz Piga
article en

Abstract

No Background: Severe alcohol-associated hepatitis (AH) is considered a common precipitant of acute-on-chronic liver failure (ACLF). This study aims to characterize the association between AH and ACLF, focusing on mortality across different ACLF grades. Multicenter prospective cohort study. We included patients admitted with severe AH between 2015–2022. The main outcome was mortality by ACLF grade during admission. The analysis included survival analysis using Cox regression. We adjusted multivariable models based on the main predictors of mortality observed in prior studies. We prospectively included 646 patients from 24 centers and 8 countries. Age 49.9±11.7 years, 85.1% of men and 64.4% had a previous diagnosis of cirrhosis. Median MELD at admission was 25 [20-31] points, 46.5% of patients were treated with corticosteroids, and only 2.2% underwent liver transplantation (LT). Around 67.4% of patients fulfilled ACLF criteria: 10.1% grade 1, 19.2% grade 2, and 38.1% grade 3. The most frequent organ dysfunctions were 76.2% liver, 40.8% brain, 43.2% coagulation, 29.6% renal, 29.4% circulatory, and 18.9% lung failure. Survival at 180 days was 77.8% (95%CI: 72.1-82.6%) in those without ACLF grade 3 and 28.0% (95%CI: 20.5–36.0%) in those with ACLF grade 3 (p<0.001). In the multivariable model adjusted by age, body mass index, and MELD score, individuals with ACLF grade 3 had lower survival than those without ACLF (HR 2.67, 95%CI: 1.50–4.76; p=0.001). However, those with ACLF grade 1 (HR 1.50, 95%CI: 0.76–2.96; p=0.243) and grade 2 (HR 0.70, 95%CI: 0.31–1.56; p=0.380) were not associated with a higher mortality than those without ACLF. Among patients with AH, only ACLF grade 3 is a major determinant of morbimortality. Thus, patients who fulfill ACLF grade 3 should promptly be referred for early LT. The redefinition of ACLF in AH is essential for better quantifying the severity and determining therapeutic goals.

Annals of HepatologyVol. 29
Universidad del Desarrollo (CL), Pontificia Universidad Católica de Chile (CL), Hospital General de México (MX), University of California System (US), Roosevelt Hospital (GT), Hospital General Dr. Manuel Gea Gonzalez (MX), Hospital Civil de Guadalajara (MX), Hospital Clínico de la Universidad de Chile (CL), Complejo Asistencial Sótero del Río (CL)
Good health and well-being
Openalex Percentile: Top 66%
Liver Disease Diagnosis and Treatment
DOIOpen Access PDFOpenAlex
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