P- 36 ACUTE ON CHRONIC LIVER FAILURE IN LATIN AMERICA: SUB-ANALYSIS OF A SYSTEMATIC REVIEW AND META-ANALYSIS

Introduction and Objectives

Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation of liver cirrhosis associated with extrahepatic organ failure, and high short-term mortality. Previous studies have estimated a global prevalence of 35% with a mortality of up to 58% at 90 days of follow-up. There is sparse data of ACLF prevalence and mortality in Latin America using the European Association for the Study of Chronic Liver Failure (EASL-CLIF) criteria. This study aimed to characterize patients with ACLF in Latin America and estimate its prevalence and mortality.

Materials and Methods

Pubmed from 01/03/2013 to 08/02/2023 was searched for Latin American cohort studies on ACLF, using the EASL-CLIF criteria. With the data obtained the meta-analysis was performed.

Results

Six studies were included in the analysis, with a total of 817 patients hospitalized for decompensated cirrhosis. The mean follow-up time was 69.9 ± 31.5 days. ACLF prevalence was 29.3%, where 81.5% of these patients had presented previous decompensation. The two-most common liver disease etiologies were alcohol-related liver disease (43.1%), and viral hepatitis (36.5%). The most common triggers identified were infections (35.8%), and gastrointestinal bleeding (22.9%). In up to 28% of the cases, the trigger remained unknown. The main organ disfunctions were renal failure (51.2%), and circulatory failure (45.9%). Overall ACLF mortality was 74.0%, with up to 84.4% in patients classified as ACLF 3.

Conclusions

ACLF is a global important health-care problem including in Latin American. The prevalence of ACLF in our study is similar to the prevalence reported worldwide, but in this region, there is a higher mortality. Our results emphasize the importance of creating local management guidelines for patients with ACLF in Latin America.