Table 1.
Baseline characteristics and outcomes in patients with ACLF, pre-ACLF, UDC and SDC.
| Characteristics | ACLF (n = 197) |
Pre-ACLF (n = 94) |
UDC (n = 251) |
SDC (n = 507) |
p∗ | p# | p§ |
|---|---|---|---|---|---|---|---|
| Male, n (%) | 176 (89.3) | 75 (79.8) | 211 (84.1) | 391 (77.1) | 0.042 | 0.436 | 0.033 |
| Age (years), (median (IQR)) | 47.6 [41.4, 54.3] | 49.6 [41.9, 57.59] | 50.87 [44.4, 57.6] | 47.8 [42.2, 56.5] | 0.252 | 0.374 | 0.011 |
| Previous decompensation, n (%) |
71 (23.1) |
39 (28.5) |
196 (51.6) |
251 (34.5) |
0.003 |
0.005 |
<0.001 |
| Decompensation, n (%) | |||||||
| HE | <0.001 | 0.129 | 0.255 | ||||
| Grade 0 | 141 (71.6) | 92 (97.9) | 235 (93.6) | 485 (95.7) | |||
| Grade 1 | 13 (6.6) | 0 (0.0) | 9 (3.6) | 7 (1.4) | |||
| Grade 2 | 30 (15.2) | 1 (1.1) | 6 (2.4) | 12 (2.4) | |||
| Grade 3 | 11 (5.6) | 0 (0.0) | 1 (0.4) | 3 (0.6) | |||
| Grade 4 | 2 (1.0) | 1 (1.1) | 0 (0.0) | 0 (0.0) | |||
| Bacterial infection | 96 (48.7) | 54 (57.4) | 69 (27.5) | 121 (23.9) | 0.206 | <0.001 | 0.320 |
| Variceal bleeding | 10 (5.1) | 8 (8.5) | 53 (21.1) | 86 (17.0) | 0.380 | 0.010 | 0.197 |
| Ascites |
154 (78.2) |
77 (81.9) |
172 (68.5) |
351 (69.2) |
0.560 |
0.020 |
0.909 |
| Laboratory data, median (IQRs) | |||||||
| TB (mg/dl) | 24.5 [17.3, 31.0] | 18.2 [8.6, 26.9] | 3.4 [1.4, 11.2] | 3.4 [1.5, 10.6] | 0.001 | <0.001 | 0.748 |
| INR | 2.8 [2.3, 3.4] | 2.06 [1.8, 2.3] | 1.5 [1.3, 1.8] | 1.5 [1.3, 1.7] | <0.001 | <0.001 | 0.013 |
| Cr (mg/dl) | 0.9 [0.7, 1.6] | 0.8 [07, 1.0] | 0.8 [0.7, 1.0] | 0.8 [0.7, 0.9] | <0.001 | 0.601 | 0.138 |
| BUN (mEq/L) | 5.5 [3.6, 11.1] | 5.1 [3.7, 6.9] | 5.0 [3.7, 7.0] | 4.6 [3.6, 6.3] | 0.062 | 0.576 | 0.051 |
| ALT (U/L) | 172.5 [57.0, 595.6] | 200.5 [60.2, 429.9] | 42.7 [23.6, 117.0] | 61.90 [29.0, 194.5] | 0.769 | <0.001 | <0.001 |
| AST (U/L) | 191.0 [89.0, 470.7] | 197.5 [97.5, 470.0] | 63.1 [34.6, 151.9] | 70.0 [40.0, 165.6] | 0.737 | <0.001 | 0.105 |
| Hemoglobin (g/L) | 117.0 [104.0, 131.0] | 118.0 [100.0, 134.8] | 109.0 [91.5, 126.5] | 113.5 [93.0, 129.0] | 0.988 | 0.006 | 0.112 |
| WBC count (109/L) | 7.2 [5.0, 10.6] | 6.1 [4.4, 8.1] | 4.2 [3.0, 6.4] | 4.4 [3.0, 6.2] | 0.003 | <0.001 | 0.970 |
| PLT (109/L) | 81.0 [50.0, 112.0] | 73.0 [47.3, 103.5] | 62.0 [42.0, 95.5] | 72.0 [51.0, 108.0] | 0.544 | 0.056 | 0.001 |
| NL ratio | 4.84 [3.01, 7.80] | 3.60 [2.35, 5.89] | 2.58 [1.68, 4.48] | 2.3 [1.5, 3.5] | 0.004 | <0.001 | 0.009 |
| Sodium (mEq/L) | 135.0 [131.0, 138.0] | 136.2 [131.7, 139.3] | 138.1 [134.6, 140.6] | 138.4 [136.0, 141.0] | 0.098 | 0.002 | 0.087 |
| Albumin (g/L) | 30.0 [26.7, 33.6] | 30.3 [27.7, 34.0] | 30.2 [25.7, 33.5] | 30.8 [26.4, 34.3] | 0.428 | 0.293 | 0.138 |
| Prealbumin (mg/L) | 41.9 [26.0, 56.3] | 47.4 [21.3, 58.5] | 59.5 [38.0, 94.5] | 62.0 [39.0, 89.4] | 0.792 | <0.001 | 0.936 |
| C-reaction protein (mg/L) | 12.5 [6.7, 19.6] | 18.0 [11.5, 28.5] | 9.4 [2.6, 20.3] | 7.4 [3.1, 15.3] | 0.005 | <0.001 | 0.313 |
| Procalcitonin (ng/ml) |
5.0 [3.1, 6.0] |
5.2 [3.7, 7.2] |
3.7 [2.0, 5.7] |
4.3 [2.7, 6.1] |
0.689 |
<0.001 |
0.842 |
| HBV parameters | |||||||
| HBV-DNA (log10 IU/ml) | 5.0 [3.1, 6.0] | 5.2 [3.7, 7.2] | 3.7 [2.0, 5.7] | 4.3 [2.7, 6.1] | 0.013 | <0.001 | 0.031 |
| Antiviral treatment history, n (%) | 130 (66.0) | 57 (60.6) | 135 (53.8) | 331 (65.3) | 0.560 | 0.066 | 0.001 |
| Antiviral naïve | 11 (5.6) | 9 (9.6) | 11 (4.4) | 35 (6.9) | |||
| <6 months | 55 (27.9) | 27 (28.7) | 104 (41.4) | 141 (27.8) | |||
| ≥6 months |
|||||||
| Severity scores, (median [IQR]) | |||||||
| MELD | 31.0 [29.0, 35.0] | 26.00 [23.0, 28.0] | 17.0 [12.0, 22.8] | 16.0 [12.0, 21.0] | <0.001 | <0.001 | 0.234 |
| iMELD | 51.0 [47.0, 57.0] | 45.0 [41.0, 48.8] | 37.0 [30.0, 42.8] | 34.0 [29.0, 39.0] | <0.001 | <0.001 | 0.002 |
| MELD-sodium | 32.0 [30.0, 36.0] | 27.0 [24.25, 30.0] | 19.0 [13.0, 25.0] | 17.0 [12.0, 23.0] | <0.001 | <0.001 | 0.041 |
| Child-Pugh | 12.0 [11.0, 13.0] | 11.0 [10.0, 12.0] | 9.0 [8.0, 11.0] | 9.0 [8.0, 10.0] | <0.001 | <0.001 | 0.462 |
| CLIF-C AD | 61.7 [56.1, 69.7] | 53.8 [47.4, 59.4] | 44.8 [39.8, 52.0] | 43.5 [38.2, 49.3] | <0.001 | <0.001 | 0.006 |
| CLIF-C ACLF | 45.3 [40.9, 49.3] | 39.0 [35.0, 42.0] | 32.1 [28.0, 38.3] | 30.9 [26.8, 35.4] | <0.001 | <0.001 | 0.006 |
| CLIF SOFA | 8.0 [7.0, 9.0] | 7.0 [6.0, 7.0] | 5.00 [3.0, 6.0] | 5.0 [3.0, 6.0] | <0.001 | <0.001 | 0.047 |
| CLIF OF |
10.0 [10.0, 11.0] |
9.00 [8.0, 9.0] |
7.0 [6.0, 8.0] |
6.0 [6.0, 8.0] |
<0.001 |
<0.001 |
0.085 |
| Organ failure | |||||||
| Liver, n (%) | 177 (89.8) | 59 (62.8) | 60 (24.0) | 110 (21.7) | <0.001 | <0.001 | 0.534 |
| Coagulation, n (%) | 139 (70.6) | 9 (9.6) | 5 (2.0) | 5 (1.0) | <0.001 | 0.005 | 0.412 |
| Kidney, n (%) | 38 (19.4) | 0 (0.0) | 0 (0.0) | 0 (0.0) | <0.001 | - | - |
| Cerebral, n (%) | 13 (6.6) | 1 (1.1) | 1 (0.4) | 3 (0.6) | 0.077 | 1.000 | 1.000 |
| Circulation, n (%) | 6 (3.0) | 0 (0.0) | 1 (0.4) | 1 (0.2) | 0.205 | 1.000 | 1.000 |
| Lungs, n (%) |
2 (1.0) |
0 (0.0) |
0 (0.0) |
0 (0.0) |
0.825 |
- |
- |
| LT-free mortality (%) | |||||||
| 28-day | 64/175 (37.1%) | 31/90 (34.4%) | 13/243 (5.7%) | 0 (0.0) | 0.145 | <0.001 | <0.001 |
| 90-day | 96/168 (56.0%) | 55/88 (60.3%) | 53/184 (19.6%) | 0 (0.0) | 0.260 | <0.001 | <0.001 |
| 1-year | 110/165 (65.1%) | 61/86 (68.8%) | 76/237 (29.8%) | 13/493 (2.1%) | 0.209 | <0.001 | <0.001 |
ACLF, acute-on-chronic liver failure; ALT alanine aminotransferase; BUN, blood urea nitrogen; CLIF-OF, Chronic Liver Failure-organ failure; CLIF-SOFA, Chronic Liver Failure-sequential organ failure assessment; Cr, creatinine; HE, hepatic encephalopathy; iMELD, integrated MELD; INR, International normalised ratio; LT, liver transplantation; PLT, platelet count; NL ratio, neutrophil-lymphocyte ratio; MELD, model of end-stage liver disease; SDC, stable decompensated cirrhosis; TB, total bilirubin; UDC, unstable decompensated cirrhosis; WBC, white blood cell.
∗
p value for comparisons between patients with ACLF and pre-ACLF.
#
p value for comparisons between patients with pre-ACLF and UDC.
§
p value for comparisons between patients with UDC and SDC.