Background Acute-on-chronic liver failure (ACLF) is a prevalent complication among cirrhosis patients, whose high mortality is linked to cirrhosis combined with ACLF. Nevertheless, there is a paucity of systematic reviews. This study aimed to illustrate whether cirrhosis is a prognostic factor for ACLF. Methodology PubMed, Embase, and Cochrane Library were searched for observational studies that explored the connection between cirrhosis and ACLF prognosis from database inception to January 10, 2025. Pooled relative risk (RR) and 95% confidence interval (CI) were utilized for data analyses. Publication bias was estimated using Egger’s tests. The protocol was registered in the PROSPERO (CRD42025639557). Results This meta-analysis included 17 articles and 8,488 patients of ACLF under different diagnostic criteria. The analyses indicated that cirrhosis did not correlate with 28-day mortality of ACLF patients (RR = 1.08, 95% CI 0.84–1.39, p = 0.550, I 2 = 88.8%) but independently predicted 90-day mortality (RR = 1.33, 95% CI 1.10–1.61, p = 0.004, I 2 = 92.6%). Subgroup analyses of cirrhosis discovered no significant difference in 28-day and 90-day mortality between non-cirrhosis patients and those with compensated cirrhosis ( p > 0.05). The 90-day mortality in decompensated cirrhosis patients was markedly higher than that in non-cirrhosis individuals (RR = 1.33, 95% CI 1.14–1.56, p < 0.001, I 2 =64.2%). Conclusions Compensated cirrhosis did not correlate with the 28-day mortality of ACLF patients, while it was an independent risk factor for 90-day mortality.
Dong et al. (Thu,) studied this question.
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