Abstract / Summary
Abstract Background and Aims: Acute-on-chronic liver failure (ACLF) has been extensively studied in hospitalised patients, but its incidence and risk factors in outpatients remain poorly defined. This study evaluated the incidence and independent risk factors for ACLF in an outpatient cohort of individuals with cirrhosis. Methods: This is a prospective, multicenter cohort study, in which baseline data were collected at the first outpatient visit of individuals with cirrhosis, who were then followed until the development of ACLF or the competing outcomes (liver transplant or death). ACLF was defined according to the Chronic Liver Failure Consortium (CLIF-C) criteria. Cumulative incidence functions (CIFs) for ACLF were calculated, and multivariate analyses were performed using the Fine–Gray competing risk model to estimate subdistribution hazard ratios (HRs) and their 95% confidence intervals (CIs). Results: A total of 881 patients were included (78.1% - Child-Pugh A, 19.9% - Child-Pugh B, 2.0% - Child-Pugh C). Eight hundred and seven patients were actually followed, among which the cumulative incidence of ACLF in 12 months was 4.5% (n=36). Independent risk factors for ACLF at 12 months included lower levels of haemoglobin (HR=0.80; 95% CI=0.69–0.93, p=0.003) and albumin (HR=0.45; 95% CI=0.26–0.76, p=0.003), higher levels of creatinine (HR=1.44; 95% CI=1.08–1.91, p=0.013), and the presence of ascites (HR=2.12; 95% CI=1.03–4.33, p=0.040). Conclusions: The cumulative incidence of ACLF was low, likely reflecting the predominance of compensated cirrhosis at study entry. Baseline markers of anaemia and liver and kidney dysfunction were independently associated with the development of ACLF.