Example of studies examining the underlying cause of chronic liver disease in acute-on-chronic liver failure (ACLF)
| First author, year (ref) | Country/region | ACLF definition | No | Viral, n (%) | Alcohol, n (%) | Alcohol+viral n (%) | Cryptogenic, n (%) | Miscellaneous, n (%) |
|---|---|---|---|---|---|---|---|---|
| Du, 200518 | China | N/R | 650 | 524 (81) | 80 (12) | 46 (7) | ||
| Xia, 201319 | China | # | 857 | 602 (70) | 56 (7) | 149 (17) | 50 (6) | |
| Kedarisetty, 201420 | Asia Pacific | APASL | 1363 | 335 (25) | 645 (47) | 220 (20) | 106 (8) | |
| Shi, 201521 | China | APASL | 540 | 405 (75) | 30 (6) | 62 (11) | 28 (5) | 15 (3) |
| Wehler, 200122 | Germany | SOFA | 143 | 20 (14) | 108 (75) | 5 (4) | 10 (7) | |
| Cholongitas, 200623 | UK | APASL | 312 | 54 (17) | 203 (65) | 14 (5) | 41 (13) | |
| Moreau, 20139 | Europe | CANONIC | 303 | 38 (12) | 170 (56) | 27 (9) | 68 (22) | |
| Bajaj, 20147 | USA | NACSELD | 507 | 124 (25) | 74 (15) | 138 (27) | 78 (15) | 93 (18) |
(#) (1) acute deterioration of pre-existing chronic liver disease; (2) extreme fatigue with severe digestive symptoms, such as obvious anorexia, abdominal distension, nausea and vomiting; (3) progressively worsening jaundice within a short period (serum total bilirubin level ≥10 mg/dL or a daily elevation ≥1 mg/dL); (4) an obvious haemorrhagic tendency with prothrombin activity ≤40% (approximate prothrombin time ≥18.3 s, international normalised ratio >1.50).
APASL, Asian Pacific Association for the Study of the Liver; CANONIC, EASL-CLIF Acute-on-Chronic Liver Failure in Cirrhosis; NACSELD, North American Consortium for Study of End-stage Liver Disease; SOFA, Sequential Organ Failure Assessment.