Impact of Metabolic Risk Factors on the Severity and Outcome of Patients with Alcohol Associated Acute-on-Chronic Liver Failure.

BACKGROUND Metabolic risk factors may impact the severity and outcome of alcoholic liver disease. Present study evaluated this effect in patients with alcohol associated acute-on-chronic liver failure(ACLF). METHODOLOGY 1216 prospectively enrolled patients with ACLF (males 98%, mean age 42.5±9.4 years, mean CTP, MELD and AARC scores of 12±1.4, 29.7±7 and 9.8±2 respectively) from the Asian Pacific Association for the Study of the Liver (APASL) ACLF Research Consortium [AARC] data base were analysed retrospectively. Patients with or without metabolic risk factors were compared for severity (CTP, MELD, AARC scores) and day 30 and 90 mortality. Information on overweight/obesity, type 2 diabetes mellitus (T2DM), hypertension and dyslipidemia were available in 1028(85%), 1019(84%), 1017(84%) and 965(79%) patients, respectively. RESULTS Overall, 392(32%) patients died at day 30 and 528 (43%) at day 90. Overweight/obesity, T2DM, hypertension and dyslipidemia were present in 154(15%), 142(14%), 66(7%) and 141(15%) patients, respectively with no risk factors in 809 (67%) patients. Patients with overweight/obesity had higher MELD scores (30.6±7.1 vs 29.2±6.9, p=0.007) and those with dyslipidemia had higher AARC scores (10.4±1.2 vs 9.8±2, p=0.014). Overweight/ obesity were associated with increased day 30 mortality (HR 1.54, 95% C.I 1.06-2.24, p=0.023). None of other metabolic risk factors, alone or in combination, had any impact on disease severity or mortality.On multivariate analysis, overweight or obesity was significantly associated with 30-day mortality (aHR 1.91, 95% C.I 1.41-2.59,p<0.001),independent of age, CTP, MELD and AARC scores. CONCLUSION Overweight/obesity and dyslipidemia increase the severity of alcohol associated ACLF, and the former also increases the short-term mortality in these patients.