Acute-On-Chronic Liver Failure In Cirrhotic Patients
Condition: Cirrhosis, Liver
MeSH terms: Liver Cirrhosis; Liver Failure; Hepatic Insufficiency; End Stage Liver Disease; Acute-On-Chronic Liver Failure; Fibrosis
Study type: Observational

Summary: 
      Cirrhosis is a condition characterized by diffuse fibrosis, severe disruption of the
      intrahepatic arterial and venous flow, portal hypertension and, ultimately, liver cell
      failure. Traditionally, cirrhosis has been dichotomised in compensated and decompensated, and
      the transition to decompensated cirrhosis happens when any of the following hallmarks occurs:
      presence of ascites, variceal haemorrhage and/ or hepatic encephalopathy (HE) . In Egypt, HCV
      is the main cause of liver cirrhosis followed by HBV
    

Detailed description: 
      Cirrhosis is a condition characterized by diffuse fibrosis, severe disruption of the
      intrahepatic arterial and venous flow, portal hypertension and, ultimately, liver cell
      failure. Traditionally, cirrhosis has been dichotomised in compensated and decompensated, and
      the transition to decompensated cirrhosis happens when any of the following hallmarks occurs:
      presence of ascites, variceal haemorrhage and/ or hepatic encephalopathy (HE). In Egypt, HCV
      is the main cause of liver cirrhosis followed by HBV. Once cirrhosis transitions from the
      compensated to the decompensated stage, it is associated with short-term survival (3-5 years)
      . The concept of acute-on-chronic liver failure (ACLF) has been widely used to study patients
      who underwent artificial support therapies as a bridge to liver transplantation (LT). In
      2009, the Asian Pacific Association for the Study of the Liver (APASL) provided the first
      consensus on ACLF, defined as "an acute hepatic insult manifesting as jaundice and
      coagulopathy, complicated within 4 weeks by ascites and/or encephalopathy". In 2014, the
      definition was further expanded to include 'high 28-day mortality'. Therefore, acute on top
      of chronic liver failure (ACLF) is defined as a syndrome characterized by acute decompensated
      cirrhosis associated with failure of various organs and high short term mortality rate; based
      on CANONIC study which is a large scale prospective study, in which the kidneys were the most
      common affected organs, followed by liver, coagulation, the brain, circulation and the lungs.
      ACLF can occur in patients with chronic liver disease without cirrhosis (type A), with
      compensated cirrhosis (type B), and with decompensated cirrhosis (type C) .In many cases, a
      precipitating factor linked to the development of ACLF can be identified including alcohol
      intake, reactivation of HBV or acute hepatitis due to HAV or HEV, bacterial infection or GI
      hemorrhage. The CLIF-C OF score which consists of numbers and types of organ failures (OFs)
      including kidneys, liver, coagulation, the brain, circulation, and the lungs is associated
      with 28-day and 90-day mortality. Moreover, some specific organ dysfunction such as kidney
      dysfunction and moderate HE, when associated with single OF, was also associated with bad
      prognosis . On this background, diagnostic criteria of ACLF were established according to the
      presence, type and number of OFs.

      The severity of ACLF was graded into different stages according to the number of OFs on ACLF
      grade 1, grade 2 and grade 3 and mortality correlates with ACLF severity.

      To predict prognosis and mortality more accurately. developed CLIF-C-ACLF score which has a
      greater prognostic capability than CLIF-C- OF, It consists of the CLIF-C- OF combined with
      age and WBCs count. Few studies have addressed the patterns of acute on chronic liver failure
      in Egyptian cirrhotic patients . Therefore, we will conduct our study to shed
    

Observational model: Case-Only
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Cirrhotic patients whether compensated or decompensated with an acute decompensation of
        cirrhosis which is defined by the recent development of ascites, encephalopathy, GI
        haemorrhage, bacterial infection, or any combination of these
      
Keywords: Cirrhosis, liver failure