Epidemiology of ACLF in the Emergency Department of Ibn Sina Hospital in Rabat

Background: Acute-on-Chronic Liver Failure (ACLF) represents a critical syndrome characterized by acute decompensation of cirrhosis with organ failure and high short-term mortality. While extensively studied in Western and Asian populations, data from North African contexts remain scarce. Objective: To describe the epidemiological, clinical, and biological characteristics of ACLF in a Moroccan tertiary care center. Methods: We conducted a retrospective cross-sectional study of 27 cirrhotic patients admitted with ACLF to the Emergency Department of Ibn Sina University Hospital in Rabat between January 2022 and July 2023. ACLF was diagnosed using the EASL-CLIF criteria based on the CLIF-SOFA score. Data on demographics, clinical presentation, laboratory values, ACLF grades, and outcomes were analyzed. Results: The mean age was 52.4 ± 14 years; 63% were male. Viral hepatitis was the predominant etiology (36%). The precipitating factor remained unidentified in 55.5% of cases, with infections accounting for 37%. Neurological failure was the most frequent organ dysfunction (85.2%). ACLF grade distribution was: Grade 1 (33.3%), Grade 2 (25.9%), and Grade 3 (40.7%). The overall mortality rate was 48.1%, rising significantly with ACLF grade (Grade 1: 11.1%, Grade 2: 71.4%, Grade 3: 72.7%). CLIF-SOFA scores correlated strongly with mortality (p = 0.017). Conclusion: ACLF in Moroccan patients is associated with high mortality and often presents with neurological dysfunction. Early identification, particularly of infectious triggers, and timely intervention are essential. Despite the grave prognosis in advanced stages, favorable outcomes remain possible with appropriate management. Larger prospective studies are needed to better define ACLF epidemiology in North Africa.