ACUTE-ON-CHRONIC LIVER FAILURE
Abstract
Background. The cause of hospitalization of patients with cirrhosis is acute decompensation, which is manifested by ascites, hepatic encephalopathy, variceal bleeding, and bacterial infections. In some patients acute decompensation develops without the occurrence/progression of these clinical syndromes, others, on the contrary, clinically demonstrate acute injury of one or two organs or multiorgan failure. In publications, a syndrome against the background of cirrhosis, acute failure of one or several organs develops is indicated as “acute-on-chronic” liver failure. The objective of the study was to assess the decompensation of cirrhosis in patients with bacterial infections based on a modified CLIF-C scale.
Material and methods. The patients underwent a complex of laboratory and instrumental studies. The assessment of the syndrome of acute-on-chronic liver failure was performed using the CLIF-C scale. Bacterial infections were diagnosed on the basis of standard criteria.
Results. Out of 151 patients with cirrhosis hospitalized to the gastroenterology department, acute-to-chronic liver failure was diagnosed in 44 patients (29.1%; 95%CI 22.0-37.1%). Bacterial infections were detected in 67 (44.4%; 95%CI 36.3-52.7%). The characteristic of clinical signs in patients with liver cirrhosis with/without acute decompensation of liver failure is presented.
Conclusion. The chance of developing ACLF-2 and ACLF-3 in cirrhotic patients with infections was 8.2 with a value of 95% CI 1.0-69.6 (NNH = 12.9; 95% CI 10.7-15.0). Bacterial infections increase the risk of acute decompensation in patients with CP (OR=2.0, p=0.048).
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