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

Affiliations
  • 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

Abstract

Background/Aims
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.
Methods
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).
Results
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.
Conclusions
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.

Keyword

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

Figure

  • 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.


Reference

1. Arroyo V, Moreau R, Jalan R. 2020; Acute-on-chronic liver failure. N Engl J Med. 382:2137–2145. DOI: 10.1056/NEJMra1914900. PMID: 32459924.
2. Gustot T, Moreau R. 2018; Acute-on-chronic liver failure vs. traditional acute decompensation of cirrhosis. J Hepatol. 69:1384–1393. DOI: 10.1016/j.jhep.2018.08.024. PMID: 30195459.
3. Hernaez R, Solà E, Moreau R, Ginès P. 2017; Acute-on-chronic liver failure: an update. Gut. 66:541–553. DOI: 10.1136/gutjnl-2016-312670. PMID: 28053053. PMCID: PMC5534763.
4. Bernal W, Jalan R, Quaglia A, Simpson K, Wendon J, Burroughs A. 2015; Acute-on-chronic liver failure. Lancet. 386:1576–1587. DOI: 10.1016/S0140-6736(15)00309-8.
5. Moreau R, Jalan R, Gines P, et al. 2013; Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis. Gastroenterology. 144:1426–1437. e14379. DOI: 10.1053/j.gastro.2013.02.042. PMID: 23474284.
6. Sarin SK, Choudhury A, Sharma MK, et al. 2019; Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific association for the study of the liver (APASL): an update. Hepatol Int. 13:353–390. DOI: 10.1007/s12072-019-09946-3. PMID: 31172417. PMCID: PMC6728300.
7. Kim TY, Song DS, Kim HY, et al. 2016; Characteristics and discrepancies in acute-on-chronic liver failure: need for a unified definition. PLoS One. 11:e0146745. DOI: 10.1371/journal.pone.0146745. PMID: 26789409. PMCID: PMC4720429.
8. Wu T, Li J, Shao L, et al. 2018; Development of diagnostic criteria and a prognostic score for hepatitis B virus-related acute-on-chronic liver failure. Gut. 67:2181–2191. DOI: 10.1136/gutjnl-2017-314641. PMID: 28928275.
9. Yoon EL, Kim TY, Lee CH, et al. 2019; Long-term prognosis of acute-on-chronic liver failure survivors. J Clin Gastroenterol. 53:134–141. DOI: 10.1097/MCG.0000000000000987. PMID: 29369242. PMCID: PMC6358187.
10. Lee M, Lee JH, Oh S, et al. 2015; CLIF-SOFA scoring system accurately predicts short-term mortality in acutely decompensated patients with alcoholic cirrhosis: a retrospective analysis. Liver Int. 35:46–57. DOI: 10.1111/liv.12683. PMID: 25203221.
11. Jalan R, Saliba F, Pavesi M, et al. 2014; Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure. J Hepatol. 61:1038–1047. DOI: 10.1016/j.jhep.2014.06.012. PMID: 24950482.
12. Jalan R, Pavesi M, Saliba F, et al. 2015; The CLIF consortium acute decompensation score (CLIF-C ADs) for prognosis of hospitalised cirrhotic patients without acute-on-chronic liver failure. J Hepatol. 62:831–840. DOI: 10.1016/j.jhep.2014.11.012. PMID: 25463539.
13. Massard J, Ratziu V, Thabut D, et al. 2006; Natural history and predictors of disease severity in chronic hepatitis C. J Hepatol. 44(Suppl 1):S19–S24. DOI: 10.1016/j.jhep.2005.11.009. PMID: 16356583.
14. Li H, Chen LY, Zhang NN, et al. 2016; Characteristics, diagnosis and prognosis of acute-on-chronic liver failure in cirrhosis associated to hepatitis B. Sci Rep. 6:25487. DOI: 10.1038/srep25487. PMID: 27146801. PMCID: PMC4857102.
15. Zhao RH, Shi Y, Zhao H, Wu W, Sheng JF. 2018; Acute-on-chronic liver failure in chronic hepatitis B: an update. Expert Rev Gastroenterol Hepatol. 12:341–350. DOI: 10.1080/17474124.2018.1426459. PMID: 29334786.
16. Mahmud N, Kaplan DE, Taddei TH, Goldberg DS. 2019; Incidence and mortality of acute-on-chronic liver failure using two definitions in patients with compensated cirrhosis. Hepatology. 69:2150–2163. DOI: 10.1002/hep.30494. PMID: 30615211. PMCID: PMC6461492.
17. Jeon H, Kim JH, Lee SS, et al. 2021; Impact of acute kidney injury on survival in patients with chronic hepatitis C: a retrospective cohort study. BMC Infect Dis. 21:301. DOI: 10.1186/s12879-021-05991-2. PMID: 33765952. PMCID: PMC7993493.
18. Engelmann C, Thomsen KL, Zakeri N, et al. 2018; Validation of CLIF-C ACLF score to define a threshold for futility of intensive care support for patients with acute-on-chronic liver failure. Crit Care. 22:254. DOI: 10.1186/s13054-018-2156-0. PMID: 30305132. PMCID: PMC6180662.
19. Shin J, Yu JH, Jin YJ, et al. 2020; Acute-on-chronic liver failure as a major predictive factor for mortality in patients with variceal bleeding. Clin Mol Hepatol. 26:540–553. DOI: 10.3350/cmh.2020.0034. PMID: 32937688. PMCID: PMC7641565.
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