ACLF with recompensated cirrhosis has ‘generally milder’ severity, better prognosis
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Key takeaways:
- The proportion of patients with ACLF grade 3 was lower in the recompensated group vs. the decompensated group.
- 1-year survival rates were higher in recompensated vs. decompensated patients.
Patients with acute-on-chronic liver failure and recompensated cirrhosis had less severe disease, lower incidence of respiratory failure and better prognosis at 1 year vs. those with decompensated cirrhosis, researchers reported.
“In clinical practice, patients with recompensated cirrhosis and compensated cirrhosis were found to have similar clinical characteristics,” Haixia Yuan, of the department of hepatology and gastroenterology at The Third Central Clinical College of Tianjin Medical University, and colleagues wrote in BMC Gastroenterology. “The concept of recompensation is relatively new, and in its absence in the past, it was impossible to distinguish the clinical features and prognosis of ACLF between patients with decompensated cirrhosis and what is now known as recompensated cirrhosis.”
They continued: “Therefore, we know little about the clinical features and prognosis of ACLF patients with recompensated cirrhosis.”
Yuan and colleagues retrospectively evaluated 461 patients (mean age, 52.1 years; 81.6% men) with ACLF admitted to Tianjin Third Central Hospital between May 2009 and May 2019. Most patients had ACLF with compensated cirrhosis (49%) while the remainder had ACLF with decompensated cirrhosis (35.1%) and ACLF with recompensated cirrhosis (15.8%). Researchers compared baseline data and survival rates at 1 year among the three groups.
Clinical features
Compared with those who had decompensated cirrhosis, patients with recompensated cirrhosis had significantly higher levels of hemoglobin, albumin and serum sodium, but significantly lower white blood cell counts and international normalized ratio.
Patients with recompensated cirrhosis also had a lower platelet count and total bilirubin compared with the compensated group.
Researchers reported no significant differences in white blood cell counts, hemoglobin, albumin, alanine aminotransferase, aspartate aminotransferase, cholinesterase, international normalized ratio, creatinine and serum sodium between the compensated and recompensated groups.
Organ failure, ACLF grade
Although incidence of respiratory failure was lower in the recompensated group compared with the decompensated group (5.5% vs. 22.8%), failure rates of other organs did not significantly differ between groups. Compared with the compensated group, incidence of circulatory failure was higher in the recompensated group (13.7% vs. 4.9%), while liver (53.4% vs. 84.1%) and respiratory (5.5% vs. 16.8%) failure were lower.
The proportion of patients with ACLF grade 3 was lower in the recompensated group vs. the decompensated group (15.1% vs. 35.8%), while the proportion of patients with ACLF grade 1 was higher (41.1% vs. 20.8%) in recompensated group vs. the compensated group.
Prognosis
Researchers noted significant differences in cumulative 28-day, 90-day, 180-day and 1-year survival rates between recompensated and decompensated patients (68.5% vs. 52.1%; 45.2% vs. 52.1%; 42.5% vs. 25.1% and 34.4% vs. 22.1%). Those differences were not significant between recompensated and compensated groups (68.5% vs. 66.9%; 45.2% vs. 43.2%; 42.5% vs. 41.1% and 34.4% vs. 38.8%).
Overall, patients with decompensated cirrhosis had the lowest cumulative rates of survival at 28 days, 90 days, 180 days and 1 year.
“Although the proportion of organ failure in ACLF patients with recompensated cirrhosis was similar to that in ACLF patients with decompensated cirrhosis, the severity in the former is generally milder and the prognosis is significantly better,” Yuan and colleagues concluded. “The baseline clinical indicators and prognosis were similar for ACLF patients with recompensated cirrhosis and ACLF patients with compensated cirrhosis.”
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