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Reply to: “Acute-on-chronic liver failure in East-Asia: an underestimated issue with limited data”
  1. Adrià Juanola1,2,3,
  2. Gabriel Mezzano1,4,
  3. James P Hamilton5,
  4. Pere Ginès1,2,3,
  5. Elsa Solà1,2,3,
  6. Ruben Hernaez6,7,8
  1. 1 Liver Unit, Hospital Clinic de Barcelona, Barcelona, Spain
  2. 2 Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
  3. 3 Centro de Investigacion Biomedica en Red Enfermedades Hepaticas y Digestivas (CIBERehd), Madrid, Spain
  4. 4 Gastroenterología - Hepatología, Hospital del Salvador. Universidad de Chile, Santiago, Chile
  5. 5 Medicine/Hepatology, Johns Hopkins Medicine, Baltimore, Maryland, USA
  6. 6 Gastroenterology and Hepatology, Depatment of Medicine, Baylor College of Medicine, Houston, Texas, USA
  7. 7 Section of Gastroenterology, Michael E DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
  8. 8 Center for Innovation in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
  1. Correspondence to Dr Ruben Hernaez, Gastroenterology and Hepatology, Baylor College of Medicine, Houston TX 77030, USA; ruben.hernaez{at}

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We read with interest the letter from Cao et al 1, and thank them for the interest in our study.2 The authors are concerned about our prevalence estimates of acute-on-chronic liver failure (ACLF) in East Asia. They attributed the difference due to our inclusion of overlapping cohorts,3–6 or failing to include two additional studies.7 8

Cao et al propose to exclude one of the two included studies published in China.3 4 While both cohorts indeed come from the same hospital around the same dates, they provide a different number of participants raising the possibility of …

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  • AJ and GM are co-first authors.

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  • Contributors All authors contributed to the design, draft and final review of the letter.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; internally peer reviewed.