Research progress on short-term prognosis of acute-on-chronic liver failure

ABSTRACT

Introduction

Acute-on-chronic liver failure (ACLF) is a clinical syndrome characterized as a severe condition with rapid progression, poor therapeutic response and poor prognosis. Early and timely evaluation of the prognosis is helpful for providing appropriate clinical intervention and prolonging patient survival.

Areas covered

Currently, there are no specific dynamic and comprehensive approaches to assess the prognosis of patients with ACLF. This article reviews the progress in evaluating the short-term prognosis of ACLF to provide future directions for more dynamic prospective large-scale multicenter studies and a basis for individualized and precise treatment for ACLF patients. We searched PubMed and Web of Science with the term ‘acute on chronic liver failure’ and ‘prognosis.’ There was no date or language restriction, and our final search was on 26 October 2022.

Expert opinion

ACLF is a dynamic process, and the best prognostic marker is the clinical evolution of organ failure over time. New prognostic markers are developing not only in the fields of genetics and histology but also toward diversification combined with imaging. Determining which patients will benefit from continued advanced life support is a formidable challenge, and accurate short-term prognostic assessments of ACLF are a good approach to addressing this issue.

KEYWORDS:

• Acute-on-chronic liver failure
• markers
• models
• treatments
• prognosis
• progress

Article highlights

• ACLF is a clinical syndrome that progresses to multiple organ failure in a short time and is characterized as a severe condition with rapid progression, a poor therapeutic response and poor prognosis.

• A large number of clinical studies have showed that general and laboratory markers, classic models are reliable indicators for evaluating the short-term prognosis of patients with ACLF.

• New prognostic markers are developing not only in the fields of genetics and histology but also toward diversification combined with imaging.

• The new models based on regression analysis, nomogram and random survival forest are of great significance in predicting the individual mortality risk of ACLF.

• The impact of some treatments on the prognosis of patients with ACLF is controversial, and determining which treatments benefit patients with ACLF and which are futile is a formidable challenge.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Luyao Ma has made key contributions to the intellectual content and design of the article, participated in the acquisition and analysis of references, drafted and revised the key contents of the article; Siqi Liu, Hao Xing and Zhenjing Jin participated in drafting and revising the key content of the article and made key contributions to the intellectual content of the article.

Data availability statement

The data that support the narrative review are openly available in PubMed at https://pubmed.ncbi.nlm.nih.gov.

Geolocation information

The Second Hospital of Jilin University, Nanguan District, Changchun City, Jilin Province, China

Additional information

Funding

This paper was funded by a grant (YDZJ202201ZYTS288) titled ‘Relationship between natural autoantibodies about tumor-associated antigens in peripheral blood and the incidence of non-small cell lung cancer,’ issued to Siqi Liu from the Jilin Provincial Department of Science and Technology.