Introduction: Acute‐on‐chronic liver failure (ACLF) is a severe complication of cirrhosis characterized by acute decompensation (AD), organ failure(s), and high mortality. Aims: To investigate the frequency and the clinical course of ACLF in intensive care unit (ICU) patients at different time points, using CLIF‐C and NACSELD criteria as well as to assess their influence on mortality. Methods: Patients admitted with AD with and without ACLF were retrospectively evaluated. Results: 595 patients (443 males, mean age: 66.6 ± 12.0 years) were admitted due to AD ( n = 381) or ACLF ( n = 214). According to the CLIF‐C criteria, 119 patients (20%) had ACLF Grade I, 63 (10.6%) had ACLF Grade II, and 32 (5.4%) had ACLF Grade III at admission. Using the NACSELD, 155 patients (26.1%) had ACLF at admission. Infection was the main factor associated with ACLF at admission ( n = 57; 27%, p = 0.001). In total, 104 (17.5%) patients died during hospitalization. ACLF grade at admission (OR: 4.6; 95% CI: 2.45–8.67; NS: 0.0001), use of vasopressors (OR: 3.83; 95% CI: 1.15–12.7; NS: 0.02), and CLIF‐C ACLF (OR: 1.12; 95% CI: 1.06–1.19; NS: 0.0001) were independently associated with in‐hospital mortality. The improvement in organ dysfunction after 7 days of intensive care was associated with a reduction in the risk of in‐hospital mortality compared to the 3‐day period (OR: 0.098; 95% CI: 0.047–0.204 vs. 0.253; 95% CI: 0.127–0.504; p < 0.00001, respectively). Conclusion: ACLF is associated with significant mortality in ICU patients, the CLIF‐C criteria appear to be more effective for prognostic assessment than NACSELD, and 7 days of intensive care may improve clinical outcomes.
Soares et al. (Wed,) studied this question.