Characteristics and discrepancies in acute-on-chronic liver failure: Need for a unified definition

Tae Yeob Kim, Do Seon Song, Hee Yeon Kim, Dong Hyun Sinn, Eileen L. Yoon, Chang Wook Kim, Young Kul Jung, Ki Tae Suk, Sang Soo Lee, Chang Hyeong Lee, Tae Hun Kim, Jeong Han Kim, Won Hyeok Choe, Hyung Joon Yim, Sung Eun Kim, Soon Koo Baik, Byung Seok Lee, Jae Young Jang, Jeong Ill Suh, Hyoung Su KimSeong Woo Nam, Hyeok Choon Kwon, Young Seok Kim, Sang Gyune Kim, Hee Bok Chae, Jin Mo Yang, Joo Hyun Sohn, Heon Ju Lee, Seung Ha Park, Byung Hoon Han, Eun Hee Choi, Chang H. Kim, Dong Joon Kim

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Background & Aim To investigate the prevalence, mortalities, and patient characteristics of Acute-on-chronic liver failure (ACLF) according to the AARC (Asian Pacific Association for the Study of the Methods We collected retrospective data for 1470 hospitalized patients with chronic liver disease (CLD) and acute deterioration between January 2013 and December 2013 from 21 university hospitals in Korea. Results Of the patients assessed, the prevalence of ACLF based on the AARC and CLIF-C definitions was 9.5% and 18.6%, respectively. The 28-day and 90-day mortality rates were higher in patients with ACLF than in those without ACLF. Patients who only met the CLIF-C definition had significantly lower 28-day and 90-day survival rates than those who only met the AARC definition (68.0% vs. 93.9%, P<0.001; 55.1%vs. 92.4%, P<0.001). Among the patients who had non-cirrhotic CLD, the 90-day mortality of the patients with ACLF was higher than of those without ACLF, although not significant (33.3% vs. 6.0%, P = 0.192). Patients with previous acute decompensation (AD) within 1- year had a lower 90-day survival rate than those with AD more than 1 year prior or without previous AD (81.0% vs. 91.9% or 89.4%, respectively, all P<0.001). Patients who had extra-hepatic organ failure without liver failure had a similar 90-day survival rate to those who had liver failure as a prerequisite (57.0% vs. 60.6%, P = 0.391). Conclusions The two ACLF definitions result in differences in mortality and patient characteristics among ACLF patients. We suggest that non-cirrhotic CLD, previous AD within 1 year, and extrahepatic organ failure should be included in the ACLF diagnostic criteria. In addition, further studies are necessary to develop a universal definition of ACLF.

Original languageEnglish
Article numbere0146745
JournalPLoS ONE
Issue number1
StatePublished - 1 Jan 2016

Bibliographical note

Publisher Copyright:
© Kim 2016 et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.


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