caa a22 4500 606239839 CHVBK 20210128101305.0 cr unu---uuuuu 210128e20150401xx s 000 0 eng 10.1007/s00508-015-0707-9 doi (NATIONALLICENCE)springer-10.1007/s00508-015-0707-9 Clinical profile, natural history, and predictors of mortality in patients with acute-on-chronic liver failure (ACLF) [Elektronische Daten] [Ivana Mikolasevic, Sandra Milic, Mladen Radic, Lidija Orlic, Zeljka Bagic, Davor Stimac] Summary: Background: Acute-on-chronic liver failure (ACLF) is an increasingly recognized entity encompassing an acute deterioration of liver function in patients with cirrhosis, either secondary to superimposed liver injury or due to extrahepatic precipitating factors such as infection culminating in the end-organ dysfunction. Its main features are reversibility and high short-term mortality due to multiorgan failure (MOF). We aimed to analyze the clinical, laboratory, and etiological predictors of mortality and outcome in patients with ACLF. Methods: We evaluated 1215 patients with chronic liver disease; 90 patients met the criteria for ACLF. Results: The most common cause of underlying chronic liver disease was alcohol, and the most common acute insult (AI) in those patients was superadded alcoholic hepatitis. In all, 50% of all patients died within 30 days (71.1 % within the first 14 days after admission). MOF was the cause of death in 70 % of cases. On multivariate analysis, high serum potassium, serum creatinine higher than 90µmol/L, and C-reactive protein > 30mg/L were found to be independent baseline predictors of mortality. APACHE II (Acute Physiology and Chronic Health Evaluation II) score was the best predictor of short-term mortality (area under the curve (AUC), 0.878). MOF was a valuable predictor of mortality (AUC, 0.923); 33 of 35 patients who had MOF at admission died. Presence of positive systemic inflammatory response syndrome criteria at admission was also correlated with in-hospital mortality (AUC, 0.742). Conclusion: ACLF is a serious condition with high short-term mortality. Because ACLF is reversible, it is necessary to identify at-risk patients as soon as possible to treat acute events in a timely manner. Springer-Verlag Wien, 2015 Acute-on-chronic liver failure (ACLF) nationallicence Acute insult nationallicence Reversibility nationallicence Mortality nationallicence Multiorgan failure (MOF) nationallicence Mikolasevic Ivana Department of Gastroenterology, Division of Internal Medicine, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia aut Milic Sandra Department of Gastroenterology, Division of Internal Medicine, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia aut Radic Mladen Department of Gastroenterology, Division of Internal Medicine, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia aut Orlic Lidija Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Rijeka, Rijeka, Croatia aut Bagic Zeljka Department of Gastroenterology, Division of Internal Medicine, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia aut Stimac Davor Department of Gastroenterology, Division of Internal Medicine, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia aut Wiener klinische Wochenschrift Springer Vienna 127/7-8(2015-04-01), 283-289 0043-5325 127:7-8<283 2015 127 508 https://doi.org/10.1007/s00508-015-0707-9 text/html Onlinezugriff via DOI BK010053 XK010053 XK010000 Metadata rights reserved Springer special CC-BY-NC licence nationallicence 1 research-article jats NATIONALLICENCE NATIONALLICENCE NL-springer NATIONALLICENCE 856 40 https://doi.org/10.1007/s00508-015-0707-9 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Mikolasevic Ivana Department of Gastroenterology, Division of Internal Medicine, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia aut NATIONALLICENCE 700 1- Milic Sandra Department of Gastroenterology, Division of Internal Medicine, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia aut NATIONALLICENCE 700 1- Radic Mladen Department of Gastroenterology, Division of Internal Medicine, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia aut NATIONALLICENCE 700 1- Orlic Lidija Department of Nephrology, Dialysis and Kidney Transplantation, University Hospital Rijeka, Rijeka, Croatia aut NATIONALLICENCE 700 1- Bagic Zeljka Department of Gastroenterology, Division of Internal Medicine, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia aut NATIONALLICENCE 700 1- Stimac Davor Department of Gastroenterology, Division of Internal Medicine, University Hospital Rijeka, Krešimirova 42, Rijeka, Croatia aut NATIONALLICENCE 773 0- Wiener klinische Wochenschrift Springer Vienna 127/7-8(2015-04-01), 283-289 0043-5325 127:7-8<283 2015 127 508