Impact of Diabetes, Drug-Induced Liver Injury, and Sepsis on Outcomes in MAFLD-Related Acute-on-Chronic Liver Failure

• Published in: The American journal of gastroenterology
• Main 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
• Format: Journal Article
• Language: English
• Published: United States 17.07.2024
• ISSN: 1572-0241

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. Patients with MAFLD-ACLF were recruited from the AARC registry. The diagnosis of MAFLD-ACLF was made when the treating unit had identified the etiology of chronic liver disease (CLD) as MAFLD (or previous nomenclature such as NAFLD, NASH, or NASH-cirrhosis). Patients with coexisting other etiologies of CLD (such as alcohol, HBV, HCV, etc.) were excluded. Data was 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. 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 (HAV and HEV, 32%), drug-induced injury (DILI, 29%) and sepsis (23%). MELD-Na and AARC scores upon admission averaged 32±6 and 10.4±1.9. At 90 days, 51% survived. Non-viral precipitant, diabetes, bilirubin, INR, 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 non-viral precipitant) and MAFLD-AARC score (+5 for each) were formed. These outperformed the standard scores in both cohorts. Almost half of MAFLD-ACLF patients die within 90 days. Diabetes and non-viral precipitants such as DILI and sepsis lead to adverse outcomes. The new MAFLD-MELD-Na and MAFLD-AARC scores provide reliable 90-day mortality predictions for MAFLD-ACLF patients.