Acute-on-chronic liver failure, a disease with high treatment costs and increasing prevalence, has a short-term mortality rate of 50 percent, according to Patrick S. Kamath, MD, DM, MBBS, professor of medicine at Mayo Clinic, Rochester, MN.
Dr. Kamath will present Monday’s AASLD State-of-the-Art Lecture Acute on Chronic Liver Failure: Pathophysiology and Therapeutic Approach.
“It’s difficult to define this condition because there are different precipitating factors around the world,” he said. “In the east, it’s reactivation of hepatitis B and, of course, alcohol. But in the west, it’s mainly alcohol.”
Dr. Kamath will define the condition and review its history and scope during his lecture.
“The incidence among patients with cirrhosis who are hospitalized is increasing, and it has increased about five times over the past 15 years,” he said.
Each hospitalization for acute-on-chronic liver failure costs about $50,000, compared with $7,000 for pneumonia or cardiac failure and $19,000 for sepsis, Dr. Kamath said. And the disease’s high mortality rate compares with a 5 percent in-hospital mortality rate for congestive heart failure and 4 percent for pneumonia.
Patients with acute-on-chronic liver failure also have a high risk of hospital readmission. Less than 20 percent are at home a year later, said Dr. Kamath, adding that they either die or go to nursing homes or hospice.
Dr. Kamath will review possible interventions for these patients and how to determine prognosis. Unfortunately, clinicians have not had a lot of success with the available treatment options, he said. His presentation will review liver support devices and discuss future directions in treatment modalities.
The growing prevalence of the condition, largely due to the increase in alcoholic liver disease, means every gastroenterologist who looks after inpatients will likely treat patients with the condition, he said.
“Patients with chronic liver disease get a precipitating event and then they get systemic inflammation,” he said. “They get infected, they get multiple organ failure and then they either require transplant soon or they’re too sick for transplant and they die. Or maybe for other reasons, they’re not candidates for liver transplantation.”
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