A study of clinical profile in patients with acute on chronic liver failure in a teritary hospital

Abstract

Aim: To study the clinical profile, aetiology, precipitating insults of patients presenting with acute on chronic liver failure. To study the various predictors of mortality and outcome of acute chronic liver failure. Materials and Methods: This prospective observational study was conducted on 50 consecutive patients of acute on chronic liver failure f o r a period of 2 years. Results: ACLF has a predominant male preponderance with a male: female ratio of 5.25:1. The mean age of patients presenting with ACLF was 40.88 ± 1.1 yrs. Most common cause of underlying liver disease is alcoholic liver disease (76 %) followed by hepatitis B (6 %). Among the alcoholic liver disease super added alcoholic hepatitis is the most common (36.8%) cause followed by acute hepatitis E (18.4%). Among patients with chronic hepatitis B, reactivation of hepatitis B is the most common cause. The cause for acute deterioration could not be found in about 13.2% of patients. Higher mean Blood urea, Creatinine, prothrombin time, INR and CRP was significantly higher in the patients who died compared to patients who survived (P<0.05.). SOFA score is a better predictor of mortality than MELD and CTP score. SOFA score of 7.5 has a sensitivity of 81.5% and specificity of 91.3 % in predicting mortality. MELD score of 36 has a sensitivity of 25.9% and specificity of 100 % in predicting mortality. CTP score of 11.5 has a sensitivity of 81.5% and specificity of 87 % in detecting mortality. Most common cause of death is the multi organ failure. Increasing number of organ failures is associated with increasing risk of death. Conclusion: ACLF is characterized by rapidly deteriorating course in a previously diagnosed or undiagnosed chronic liver disease with a potential for reversibility. It has generally been shown that MELD and SOFA scores are better predictors of mortality than Child score and APACHE score