Engelbert Simon
Cardinal Santos Medical Center, Philippines
Title: Etiology, Clinical Profile, and Predictors of Mortality of Acute-On-Chronic Liver Failure in a Tertiary Hospital: A Retrospective Study
Biography
Biography: Engelbert Simon
Abstract
Acute-on-chronic liver failure (ACLF) is an increasingly recognized entity defined as a clinical syndrome in which two insults to the liver are operating simultaneously, one of them being ongoing and chronic, and the other, acute. The objective is to determine the causes and clinical profiles of ACLF at Cardinal Santos Medical Center in the Philippines, and in so doing, find instruments to help physicians predict mortality. This retrospective study was conducted at the Department of Internal Medicine of Cardinal Santos Medical Center. This study included all the patients who met the inclusion criteria of ACLF based on the Asian Pacific Association for the Study of the Liver (APASL) criteria from 2013-2015. Comparison between the survivors and non-survivors was done using the Mann-Whitney U test as a statistical tool. Associations of sex, encephalopathy, ascites and acute insults to mortality were determined by the Fisher-Exact test. Logistic regression was used to determine the important factors to predict mortality. The leading acute insult identified was alcohol accounting for 25.8%. Mortality is associated with the following: elevated bilirubin, elevated INR, low PT % Activity, elevated AST, elevated ALT, elevated creatinine, elevated MELD and elevated MELDNa. Significant association between encephalopathy and mortality was detected at 5% level of significance. The probability of death in patients with ACLF increased with the rise in bilirubin, INR, AST, ALT or creatinine levels. Encephalopathy is associated to “death due to ACLF”. Based on initial analysis, the following factors are the significant predictors of mortality: MELD, MELDNa and INR.