S2876 Long-Term Outcomes in Patients With Acute-on-Chronic Liver Failure Compared to Acute Decompensation of Cirrhosis

Introduction: Acute On Chronic Liver Failure (ACLF) is distinct clinical entity with high short-term mortality. Compared ACLF, acute decompensation of cirrhosis (AD) carries relatively lower short-term mortality due to less severe insult. Even though short-term mortality of these 2 conditions well documented, comparison of long-term outcome among these 2 conditions still not well established. Therefore, we did a retrospective observational study to compare long-term outcome of ACLF patients with AD as well as to identify the factors associated with unfavourable outcome. Methods: In this retrospective cohort study, we included 112 ACLF patients according to APASL criteria and 109 AD patients. Data collected included demographics, disease etiology, complications, blood counts, liver and renal function tests, serum lactate, hospital admissions, and mortality. Results: Among 221 patients, majority were man (87.8%) with a median age of 50 and alcohol was the most common etiology (50.7%). Upper GI bleed was the leading event in the AD group (67.2%, P < 0.001). One-year mortality was significantly higher in ACLF (41%, P < 0.001) than AD (11%, P < 0.001). Estimated mean survival was 326.94 days (±9.24) for AD and 222.36 days (±16.16, P < 0.001) for ACLF. In ACLF, the AARC grade-III subgroup had a lower mean survival (51.22 days) than grade-II (246.21 days), a significant difference (P < 0.001). Patients with CLIF-AD scores >60 had a mean survival of 293.11 days, slightly lower than 349.1 days for those scoring below 60. While the ACLF group had highest short term (30 days, 36.6%), mortality in AD was highest between 91-365 days. The area under the curve (AUC) for CLIF-ACLF >48.5 was 86% (sensitivity 84.8%, specificity 72.7%), and for CTP score >12.5 was 69.6% (sensitivity 52.2%, specificity 81.8%). CLIF-ACLF demonstrated superior prognostic discrimination compared to CTP (P = 0.005). Among AD patients, CTP, MELD and CLIFF-AD scores were similar in predicting long term outcomes. In ACLF patients AARC and ACLF-CLIFF scores showed trend towards better performance predicting the long-term outcomes. Conclusion: Alcohol is emerging as major etiology in both the group. Even though ACLF carries high short-term mortality, their long-term survival is slightly better than AD. Existing scores are not helpful in predicting long term outcome among ACLF patients, stressing the need for better score for these group of patients.