| Title: |
Impact of Diabetes, Drug-Induced Liver Injury, and Sepsis on Outcomes in Metabolic Dysfunction Associated Fatty Liver Disease-Related Acute-on-Chronic Liver Failure |
| Authors: |
Kumar, Ashish; Arora, Anil; Choudhury, Ashok; Arora, Vinod; Rela, Mohamed; Jothimani, Dinesh Kumar; Mahtab, Mamun A.; Devarbhavi, Harshad; Eapen, Chundamanni E.; Goel, Ashish; Yaghi, Cesar; Ning, Qin; Chen, Tao; Jia, Jidong; Zhongping, Duan; Hamid, Saeed S.; Butt, Amna S.; Jafri, Wasim; Shukla, Akash; Tan, Seok S.; Kim, Dong J.; Saraya, Anoop; Hu, Jinhua; Sood, Ajit; Goyal, Omesh; Midha, Vandana; Pati, Girish K.; Singh, Ayaskant; Lee, Guan H.; Treeprasertsuk, Sombat; Thanapirom, Kessarin; Mandot, Ameet; Maghade, Ravikiran; Lesmana, Rinaldi C.; Ghazinyan, Hasmik; Mohan Prasad, Virukalpatti G.; Dokmeci, Abdul K.; Sollano, Jose D.; Abbas, Zaigham; Shrestha, Ananta; Lau, George K.; Payawal, Diana A.; Shiha, Gamal E.; Duseja, Ajay; Taneja, Sunil; Verma, Nipun; Rao, Padaki N.; Kulkarni, Anand V.; Karim, Fazal; Saraswat, Vivek A.; Alam, Shahinul; Chowdhury, Debashis; Kedarisetty, Chandan K.; Saigal, Sanjiv; Sharma, Praveen; Yattoo, Ghulam N.; Koshy, Abraham; Patwa, Ajay K.; Elbasiony, Mohamed; Rathi, Pravin M.; Maharshi, Sudhir; Dayal, Vishwa M.; Jha, Ashish K.; Kalista, Kemal F.; Gani, Rino A.; Yuen, Man F.; Singh, Virendra; Sargsyan, Violeta A.; Huang, Chien H.; Mukewar, Saurabh S.; Xin, Shaojie; Rajaram, Ruveena B.; Panackel, Charles; Dadhich, Sunil; Sachdeva, Sanjeev; Kumar, Ajay; Behera, Sanatan; Kamani, Lubna; Saithanyamurthi, Hemamala V.; Prasad, Babita; Sarin, Shiv K. |
| Publisher Information: |
Lippincott, Williams & Wilkins |
| Publication Year: |
2025 |
| Collection: |
University of Hong Kong: HKU Scholars Hub |
| Subject Terms: |
AARC score; ACLF; DILI; liver failure; MELD; metabolic dysfunction-associated steatotic liver disease (MASLD); sepsis |
| Description: |
INTRODUCTION:The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and its complication, MAFLD-related acute-on-chronic liver failure (MAFLD-ACLF), is rising. Yet, factors determining patient outcomes in MAFLD-ACLF remain understudied.METHODS:Patients with MAFLD-ACLF were recruited from the Asian Pacific Association for the Study of the Liver-ACLF Research Consortium (AARC registry). The diagnosis of MAFLD-ACLF was made when the treating unit had identified the etiology of chronic liver disease as MAFLD (or previous nomenclature such as non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, or non-alcoholic steatohepatitis-cirrhosis). Patients with coexisting other etiologies of chronic liver disease (such as alcohol, hepatitis B virus, hepatitis C virus, etc.) were excluded. Data were randomly split into derivation (n = 258) and validation (n = 111) cohorts at a 70:30 ratio. The primary outcome was 90-day mortality. Only the baseline clinical, laboratory features and severity scores were considered.RESULTS:The derivation group had 258 patients; 60% were male, with a mean age of 53. Diabetes was noted in 27% and hypertension in 29%. The dominant precipitants included viral hepatitis (hepatitis A virus and hepatitis E virus, 32%), drug-induced injury (drug-induced liver injury, 29%), and sepsis (23%). Model for End-Stage Liver Disease-Sodium (MELD-Na) and AARC scores on admission averaged 32 ± 6 and 10.4 ± 1.9. At 90 days, 51% survived. Nonviral precipitant, diabetes, bilirubin, international normalized ratio, and encephalopathy were independent factors influencing mortality. Adding diabetes and precipitant to MELD-Na and AARC scores, the novel MAFLD-MELD-Na score (+12 for diabetes, +12 for nonviral precipitant), and MAFLD-AARC score (+5 for each) were formed. These outperformed the standard scores in both cohorts.DISCUSSION:Almost half of patients with MAFLD-ACLF die within 90 days. Diabetes and nonviral precipitants such as drug-induced liver injury and sepsis lead to adverse ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
The American Journal of Gastroenterology; 826; 816; https://hub.hku.hk/handle/10722/362646; 120 |
| DOI: |
10.14309/ajg.0000000000002951 |
| Availability: |
https://hub.hku.hk/handle/10722/362646; https://doi.org/10.14309/ajg.0000000000002951 |
| Rights: |
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License. |
| Accession Number: |
edsbas.A4BD9E6D |
| Database: |
BASE |