Clinical Profile, Precipitating Factors, and Predictors of In-Hospital Mortality in Patients With Acute-on-Chronic Liver Failure: A Cross-Sectional Study From a Tertiary Care Centre in Central India

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BackgroundAcute-on-chronic liver failure (ACLF) is a distinct clinical syndrome characterised by acute hepatic decompensation in patients with chronic liver disease (CLD), frequently accompanied by extrahepatic organ failure and high short-term mortality.Region-specific data on the clinical profile, precipitating factors, and factors associated with outcome in ACLF remain limited in Indian tertiary care settings. ObjectivesTo describe the clinical features, biochemical parameters, precipitating factors, organ dysfunction, and severity-score profile of patients with ACLF, and to evaluate factors associated with in-hospital mortality, using the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) and Asian Pacific Association for the Study of the Liver (APASL) ACLF Research Consortium (AARC) scoring systems. MethodsThis prospective observational cohort study enrolled 75 consecutive patients diagnosed with ACLF as per APASL criteria at a tertiary care teaching hospital.Demographic, clinical, biochemical, and severity-score data [Child-Turcotte-Pugh (CTP), model for end-stage liver disease (MELD), MELD-Na, sequential organ failure assessment (SOFA), and AARC scores] were recorded at admission, and patients were followed prospectively until in-hospital discharge or death.Categorical variables were compared using the chi-square test (with Yates' continuity correction for 2×2 tables) and continuous variables using the independentsamples t-test; all analyses were univariate. ResultsOf 75 patients, 66 (88.0%) were male, with a mean age of 47.0 ± 13.7 years.Jaundice (72/75, 96.0%) and ascites (68/75, 90.7%) were the commonest presenting features.Alcohol-related CLD (41/75, 54.7%) was the leading aetiology, and infection (25/75, 33.3%) -predominantly spontaneous bacterial peritonitis -was the commonest precipitating event.Fifty patients (50/75, 66.7%) were CTP class C, 39/75 (52.0%) had a MELD score ≥30, and 34/75 (45.3%) had an AARC score ≥10.In-hospital mortality was 46.7% (35/75) and rose significantly with ACLF grade (14.3% [4/28], 51.9% [14/27], and 85.0% [17/20] in grades 1, 2, and 3, respectively; χ²=23.90,p<0.001).Non-survivors had significantly higher bilirubin, creatinine, international normalised ratio (INR), MELD, MELD-Na, SOFA, AARC score, and serum lactate, and significantly lower serum sodium than survivors (all p<0.01).Multi-organ failure (26/35, 74.3% vs 4/40, 10.0%, p<0.0001) and an AARC score ≥10 (27/35, 77.1% vs 7/40, 17.5%, p<0.0001) showed the strongest univariate association with mortality. ConclusionACLF in this Indian cohort predominantly affected middle-aged men with alcohol-related CLD, commonly precipitated by infection.In-hospital mortality was high and closely tracked the burden of organ failure.Hyperbilirubinaemia, coagulopathy, renal dysfunction, hyponatraemia, hyperlactataemia, and elevated MELD, SOFA, and AARC scores were factors significantly associated with in-hospital death on univariate analysis, supporting further evaluation of organ failure-based scoring systems for risk stratification in ACLF.