Prognostic Factors Related to the Mortality Rate of Acute-on-Chronic Liver Failure Patients

Jian Zhang,1,2,* Junfeng Li,3,* Yu Chen,1,2 Mei Ding,1,2 Zhongping Duan1,2 1Difficult & Complicated Liver diseases and Artificial Liver Center, Beijing Youan Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, People’s Republic of China; 3The First Hospital of Lanzhou University, Department of Infectious Diseases, Lanzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jian Zhang Email zhangdajian1978@ccmu.edu.cnBackground: Critical illness-related corticosteroid insufficiency (CIRCI) is known to be a common complication in patients with acute-on-chronic liver failure (ACLF). However, factors that predict the survival rate of ACLF patients remain unclear. The present study aims to determine the prognostic factors that impinge on the survival rate of ACLF patients.Methods: A total of 90 patients with ACLF at different stages, with or without CIRCI, were prospectively evaluated.Results: Various clinical factors were found to be significantly different among patients at early, mid and late stages of ACLF, as well as between the same population of patients with and without CIRCI. Specifically, patients at later stages of ACLF and patients with CIRCI had significantly higher Child–Turcotte–Pugh (CTP), Model for End-Stage Liver Disease (MELD) and ACLF Research Consortium (AARC)-ACLF scores. CIRCI was observed in 20% of the enrolled patients (18 out of 90). In addition, the 90-day mortality rate was higher in mid- and late-stage ACLF patients, as well as patients with CIRCI.Conclusion: ACLF stage and CIRCI predict early mortality in patients with ACLF and could be actively monitored in these patients for prioritized liver transplantation.Keywords: CIRCI, liver failure, mortality, stag