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Chronic Hepatic Diseases Generate High Costs to Europe
Date:4/19/2012

orsening of patients' health, direct and indirect costs.

In a separate study the EASL-CLIF consortium report that 28 day mortality for Acute-on-Chronic liver failure (ACLF) is 35.5%[2]. The consortium set out to address questions around ACLF, a poorly defined syndrome characterized by acute deterioration of cirrhosis, representing a main cause of hospitalisation and death. At present, no diagnostic criteria and information on prevalence, pathogenesis or prognosis are available. The consortium aimed to develop a new score (CLIF-SOFA, derived from the existing sequential organ failure assessment score) to assess the severity and number of organ failures.

1,379 patients, admitted to 29 hospitals due to complications of cirrhosis, were enrolled in this observational prospective European CANONIC study. Data presented at The International Liver Congress™2012 reports on results of the first 920 cases.


Four grades of ACLF were identified:

  • ACLF-1: renal failure or a nonrenal organ failure associated with creatinine 1.5-2 mg/dL and/or grade I-II encephalopathy
  • ACLF-2: 2 organ failures
  • ACLF-3: 3 organ failures
  • ACLF-4: 4-6 organ failures

The overall prevalence of ACLFwas 22.6% with twenty-eight-day mortality of ACLF patients at 35.3% compared (but as high as 85.7% in ACLF-4 patients) to only 4.1% in patients without ACLF. ACLF often developed in patients with previously compensated (21%) or recently decompensated (< 3 months, 18%) cirrhosis and was significantly associated with bacterial infections and active alcoholism, but not gastrointestinal hemorrhage. Hepatitis, TIPS, paracentesis without albumin and surgery were infrequent precipitating events. In about 20% of cases no precipitating event was identified. ACLF was associated with an inflammatory reaction (both in infected and not infected patients) as estimated by increased WBC and plasm
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SOURCE European Association for the Study of the Liver
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