Single Jaundice in Cirrhosis: A Neglected Acute Decompensation of Acute‐on‐Chronic Liver Failure and Mortality

OBJECTIVES: To compare the risk of acute-on-chronic liver failure (ACLF) and short-term outcomes among cirrhotic patients with single jaundice, acute decompensation (AD) (including ascites, variceal bleeding, hepatic encephalopathy, and/or bacterial infection), and non-AD non-jaundice. METHODS: We analyzed cirrhotic inpatients without obstructive jaundice enrolled from two large multicenter prospective cohorts. Patients were divided at admission into classical AD, single jaundice, or non-AD non-jaundice groups. Baseline characteristics, ACLF development, and short-term outcomes were compared between groups. RESULTS: Among 2645 cirrhotic patients, classical AD, single jaundice, and non-AD non-jaundice were observed in 2163 (81.78%), 267 (10.09%), and 215 (8.13%), respectively. The 90-day liver transplant (LT)-free mortality was comparable between single jaundice patients and classical AD patients (15.09% vs. 17.81%, p = 0.266), but significantly higher than non-AD non-jaundice patients (2.45%; p < 0.01). The prevalence of ACLF (16.10% vs. 16.09%, p = 1.000) and pre-ACLF (9.36% vs. 6.43%, p = 0.094) were comparable between the single jaundice and classical AD groups. Intrahepatic precipitants, particularly hepatitis B flare with hepatitis B virus (HBV) reactivation (odds ratio [OR] 2.69; p = 0.002), spontaneous hepatitis B flare with high HBV-DNA load (OR 23.75; p < 0.001), superimposed hepatitis A/E virus infection on HBV infection (OR 13.40; p < 0.001) and hepatotoxic drug usage (OR 3.64; p < 0.001) were associated with single jaundice. CONCLUSIONS: Cirrhotic inpatients with single jaundice show comparably high short-term mortality and ACLF risk to those with classical AD. Single jaundice shall be considered as an AD event and is predominantly triggered by intrahepatic insults, warranting surveillance equivalent to classical AD and prioritized management of the precipitants.

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Publication Details

Journal
Journal of Digestive Diseases
Published
2026-10-15
DOI
https://doi.org/10.1111/1751-2980.70075
Primary Topic
Liver Disease and Transplantation
Type
article
Field-Weighted Citation Impact
0.00

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article

Single Jaundice in Cirrhosis: A Neglected Acute Decompensation of Acute‐on‐Chronic Liver Failure and Mortality

Xiuhua Jiang, Yubao Zheng, Xiaobo Lu, Zhongji Meng et al.
Journal of Digestive Diseases
Liver Disease and Transplantation
article

Single Jaundice in Cirrhosis: A Neglected Acute Decompensation of Acute‐on‐Chronic Liver Failure and Mortality

Xiuhua Jiang, Yubao Zheng, Xiaobo Lu, Zhongji Meng, Zhi Ping Qian, Yan Hang Gao, Wenting Tan, Xin Zheng, Pei‐Xuan Ji, Yu Shi, Adila Abuduaini, Hai Li, Wen Gu, Huang Yan, Yingli He, Ya Wen Lu, Jian Yi Wei, Kai He, Xian Bo Wang, Xin Zheng, Liang Qiao, Yue Xiang Bian, Feng Liu, Yan Zhang
article en

Abstract

OBJECTIVES: To compare the risk of acute-on-chronic liver failure (ACLF) and short-term outcomes among cirrhotic patients with single jaundice, acute decompensation (AD) (including ascites, variceal bleeding, hepatic encephalopathy, and/or bacterial infection), and non-AD non-jaundice. METHODS: We analyzed cirrhotic inpatients without obstructive jaundice enrolled from two large multicenter prospective cohorts. Patients were divided at admission into classical AD, single jaundice, or non-AD non-jaundice groups. Baseline characteristics, ACLF development, and short-term outcomes were compared between groups. RESULTS: Among 2645 cirrhotic patients, classical AD, single jaundice, and non-AD non-jaundice were observed in 2163 (81.78%), 267 (10.09%), and 215 (8.13%), respectively. The 90-day liver transplant (LT)-free mortality was comparable between single jaundice patients and classical AD patients (15.09% vs. 17.81%, p = 0.266), but significantly higher than non-AD non-jaundice patients (2.45%; p < 0.01). The prevalence of ACLF (16.10% vs. 16.09%, p = 1.000) and pre-ACLF (9.36% vs. 6.43%, p = 0.094) were comparable between the single jaundice and classical AD groups. Intrahepatic precipitants, particularly hepatitis B flare with hepatitis B virus (HBV) reactivation (odds ratio [OR] 2.69; p = 0.002), spontaneous hepatitis B flare with high HBV-DNA load (OR 23.75; p < 0.001), superimposed hepatitis A/E virus infection on HBV infection (OR 13.40; p < 0.001) and hepatotoxic drug usage (OR 3.64; p < 0.001) were associated with single jaundice. CONCLUSIONS: Cirrhotic inpatients with single jaundice show comparably high short-term mortality and ACLF risk to those with classical AD. Single jaundice shall be considered as an AD event and is predominantly triggered by intrahepatic insults, warranting surveillance equivalent to classical AD and prioritized management of the precipitants.

Journal of Digestive Diseases
Hubei University of Medicine (CN), Central South University (CN), Army Medical University (CN), Shandong University (CN), Sun Yat-sen University (CN), Shanghai Jiao Tong University (CN), Capital Medical University (CN), Fudan University (CN), Renji Hospital (CN), First Affiliated Hospital of Xinjiang Medical University (CN), Tianjin Nankai Hospital (CN), Nanfang Hospital (CN), Second Hospital of Shandong University (CN), Shanghai Public Health Clinical Center (CN), Tianjin People's Hospital (CN), First Affiliated Hospital of Xi'an Jiaotong University (CN), First Hospital of Jilin University (CN), Wuhan Union Hospital (CN), Southwest Hospital (CN), Second Hospital of Tianjin Medical University (CN), Third Affiliated Hospital of Sun Yat-sen University (CN), Beijing Ditan Hospital (CN), Xiangya Hospital Central South University (CN), Union Hospital (CN), First Affiliated Hospital Zhejiang University (CN), Huazhong University of Science and Technology (CN), Tianjin Medical University (CN), Southern Medical University (CN), Zhejiang University (CN)
Shandong University, National Natural Science Foundation of China, Capital Medical University, Fudan University, Zhejiang University, Xinjiang Medical University, Shanghai Jiao Tong University, Southern Medical University, Fuzhou General Hospital, Nanfang Hospital, Southwest Hospital, Army Medical University, Hubei University of Medicine, Henan Provincial People's Hospital, Renji Hospital, Xiangya Hospital, Central South University, National Key Research and Development Program of China, Tongji Medical College, Huazhong University of Science and Technology, First Hospital of Jilin University
Good health and well-being
Openalex Percentile: Top 15%
Liver Disease and Transplantation
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