FUELING THE FIRE: INFECTIONS TRIGGER AND MALNUTRITION DRIVES SEVERE ACLF IN CIRRHOSIS

Introduction and Objectives

Cirrhosis-associated immune dysfunction (CAID) increases the risk of infections, which are the most common trigger of acute-on-chronic liver failure (ACLF), a syndrome with high short-term mortality. Malnutrition may further impair immune function and affect the course of ACLF. This study aimed to elucidate the interplay between nutritional status, cirrhosis etiology, infection type, their combined impact on ACLF severity and clinical outcomes.

Materials and Methods

A retrospective analysis of 19 cirrhotic patients with ACLF treated between February 2023 and January 2024 at a tertiary centre was conducted. Data included infection type, nutritional status, cirrhosis etiology, ACLF grade, and in-hospital mortality.

Results

A total of 19 patients (6 females [32%],13 males [68%]), median age of 68 years (range 40–80) were included. Infections were the trigger for ACLF in 13 patients (68%), most commonly respiratory. Fungal or polymicrobial infections were identified in 6 patients (32%), including Klebsiella pneumoniae, Candida spp., Chlamydia sp., and Mycoplasma pneumoniae. Among patients with ACLF grade 3, 4 of 6 (67%) had fungal or polymicrobial infections. Malnutrition was observed in 9 patients (47%), including 3 of 6 (50%) with ACLF grade ≥2. It was more common in alcoholic cirrhosis (7 of 12; 58%) than in non-alcoholic cases (2 of 7; 29%). In-hospital mortality occurred in 6 patients (32%); 3 deaths (50%) were infection-related and 4 (67%) involved malnourished patients.

Conclusions

Malnutrition, alcohol-related cirrhosis, fungal or polymicrobial infections were associated with more severe ACLF and poorer outcomes. Early recognition of these risk factors may improve prognostication and guide therapy.

Conflict of interest: None

Key clinical features by ACLF severity