The Role of Inflammation in Acute-On Chronic Liver Failure (ACLF) in Patients with Decompensated Liver Cirrhosis

Introduction Acute-on chronic liver failure (ACLF), a syndrome diagnosed in cirrhotic patients with acute decompensation, has been associated with high rates of organ failure and short-term mortality. The systemic inflammatory response syndrome (SIRS) has been associated with a poor prognostic and with high risk for developing ACLF. We investigated the predictive role of SIRS in patients with decompensated liver cirrhosis hospitalized in our gastroenterology unit with regarding to ACLF and outcome. Patients and Methods Consecutive patients hospitalized for decompensation of their liver cirrhosis were included between 2015 and 2016. Diagnosis of ACLF was established in the setting of organ failure, according to the CLIF Consortium Organ Failure Score. Patients were followed for 90 days. Results One hundred forty-five patients were included, mean age 63.5 +/- 7.7 years, mostly men, 88 (60.7%). MELD and Child-Pugh scores were 29.32 +/- 11.77 and 6.96 +/- 2.5, respectively. ACLF was diagnosed in 98 (67.6%) of the participants. SIRS was found in 92 (63.4%) of all the patients included and in 82 (83.7%) of the ones with ACLF. Univariate analysis showed that patients with SIRS had a high risk for ACLF (OR=3.93; 95% CI, 2.25-6.86, P<0.05) and a high risk for 28-day and 90-day mortality (OR=1.76; 95% CI, 1.35-2.29, P<0.05, and OR=1.98; 95% CI, 1.32-2.96, P<0.05, respectively). ROC analysis showed good specificity and sensitivity for C-reactive protein in predicting ACLF with the area under the curve of 0.890. Conclusions ACLF was frequently diagnosed in cirrhotic patients with acute decompensation. SIRS was a common finding among patients with decompensated liver cirrhosis and was associated with ACLF, and with a high risk of mortality both at 28 and at 90 days. High CRP values could represent markers for poor prognosis and clinical prediction of ACLF development.