Objectives:The Acute on Chronic Liver failure (ACLF) diagnostic criteria and prognostic score have been well established and the major cause for cirrhosis is chronic alcoholic liver disease (CANONIC study). However, this criteria has not yet been studied in Asia, where chronic hepatitis infection is more prevalent. We aimed to determine the outcome of Thai patients with ACLF and validate the CLIF-C organ failure (CLIF-C OF) score for ACLF diagnosis and CLIF-ACLF score for predicting prognosis. 

Materials and Methods:We prospectively enrolled cirrhotic patients hospitalized with acute decompensation (AD). Primary end point was 3-month mortality. Factors associated with mortality were determined using logistic regression analysis. 

Results:We enrolled 95 cirrhotic patients with mean age of 56 years. The most common etiology of cirrhosis was chronic viral hepatitis infection (48.5%) and alcoholism (44.2%). Forty patients (42%) were diagnosed with ACLF. The 3-month mortality rate was well correlated with the 3 ACLF subclasses, i.e. 45.5%, 53.6% and 80% respectively. From the multivariate analysis, CLIF-ACLF score was the only independent predictor for the 3-month mortality in the ACLF group (adjusted OR 1.114, p=0.008). Additionally, CLIF-ACLF score had the AUROC of 0.78 which was significantly higher than the other 4 scores studied (p<0.05).

Conclusion:ACLF is a distinct condition associated with high mortality and organ failures. CLIF-C organ failure (CLIF-C OFs) and CLIF-ACLF scores can be used to diagnose, classify and prognose ACLF in the Thai population.

Keywords:Acute-on-chronic liver failure, Outcome, Prognosis