Korean J Gastroenterol.  2022 Oct;80(4):169-176. 10.4166/kjg.2022.050.

Clinical Features of Hepatitis C Virus-related Acute-on-chronic Liver Failure in a Korean Population

  • 1Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
  • 2Department of Internal Medicine, Gyeongsang National University Changwon Hospital, Gyeongsang National University School of Medicine, Changwon, Korea
  • 3Institute of Health Sciences, Gyeongsang National University, Jinju, Korea


Acute-on-chronic liver failure (ACLF) is a widely recognized concept in which acute decompensation (AD) in patients with cirrhosis results in organ failure and high short-term mortality. On the other hand, few studies reflecting the various etiologies of cirrhosis are available. This study examined the clinical features of patients with hepatitis C virus (HCV)-related ACLF.
Between January 2005 and December 2018, 109 HCV-related cirrhosis patients hospitalized for AD (ascites, hepatic encephalopathy, gastrointestinal hemorrhage, and bacterial infection) were enrolled for ACLF defined by the European Association for the Study of the Liver (EASL).
ACLF developed in 35 patients (32.1%) on admission. Eight, eight, and 19 patients had ACLF grades 1, 2, and 3, respectively. The 28-day and 90-day mortality rates were very low (2.7% and 5.4%, respectively) in patients without ACLF and very high (60.0% and 74.3%, respectively) in those with ACLF. In patients with HCV-related ACLF, compared to previous studies on hepatitis B virus-related ACLF and alcohol-related ACLF, the prevalence of liver failure was very low (17.1%), whereas that of kidney failure was very high (71.4%). Compared with all other prognostic scores, the Chronic liver failure Consortium Organ Failure score predicted the 90-day mortality most accurately, with an area under the receiver operator characteristic of 0.921.
HCV-related ACLF has unique clinical characteristics distinct from hepatitis B virus-related and alcohol-related ACLF. ACLF defined by EASL can be useful for predicting the short-term mortality in HCV-related cirrhosis.


Acute-on-chronic liver failure; Hepatitis C virus; Mortality; Organ failures; Acute decompensation


  • Fig. 1 Flow sheet. HCC, hepatocellular carcinoma; HBV, hepatitis B virus; HIV, human immunodeficiency virus; HCV, hepatitis C virus; ACLF, acute-on-chronic liver failure; APASL, Asian Pacific Association for the Study of the Liver.

  • Fig. 2 Prognosis according to ACLF. (A) Kaplan–Meier curves of the probability of survival within 90 days. (B) Mortality at 28 days, 90 days, and 1 year of patients without or with ACLF. ACLF, acute-on-chronic liver failure.

  • Fig. 3 Receiver operating characteristic curves of the CLIF-C OF score and three prognostic scoring systems in predicting the 90-day mortality in HCV-related cirrhosis with acute decompensation (n=109). CLIF-C OF, chronic liver failure Consortium Organ Failure score; MELD, model for end-stage liver disease; CTP, Child–Turcotte –Pugh; HCV, hepatitis C virus.


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