{
  "abstract": "Objective Acute-on-chronic liver failure (ACLF) is associated with high short-term mortality. However, long-term outcomes among hospital survivors remain incompletely characterised. We evaluated postdischarge survival, readmissions and hepatic recompensation in patients hospitalised with acute decompensation (AD), with or without ACLF.Method This is a single-centre, retrospective, real-world cohort study with 387 patients with cirrhosis admitted with AD between 2018 and 2021; 69 had ACLF at or during index admission. Survivors were followed for 36 months. Competing risk analyses were used to assess mortality, liver transplantation and recompensation according to Baveno VII criteria.Results Among 330 patients discharged alive, cumulative 36-month survival was higher in ACLF cohort than in patients without ACLF (52.6% vs 40.7%, p=0.032) when liver transplantation is treated as competing risk. Model for end-stage liver disease-sodium (MELD-Na) at discharge independently predicted lower postdischarge survival (HR 1.08, 95% CI 1.04 to 1.11, p<0.001), whereas ACLF status did not. Recompensation at 36 months occurred more frequently in ACLF survivors when compared with patients without ACLF (21.1% vs 9.9%). In multivariable competing risk analysis, ACLF independently predicted recompensation (subdistribution HR (sHR) 2.23, 95% CI 1.10 to 4.52, p=0.027), while higher MELD-Na reduced its likelihood (sHR 0.91, 95% CI 0.86 to 0.97, p=0.006).Conclusion Among patients with cirrhosis discharged from hospital following AD, prior ACLF does not confer a worse long-term prognosis and is independently associated with higher rates of delayed recompensation. Hepatic reserve at the time of discharge, rather than admission severity, determines long-term outcome.",
  "authors": [
    {
      "affiliations": [
        "Liver Failure Group, University College London Institute for Liver and Digestive Health, London, UK",
        "Tropical Medicine Department, Mansoura University Faculty of Medicine, Mansoura, Dakahlia Governorate, Egypt"
      ],
      "name": "Ahmed El-Shabrawi"
    },
    {
      "affiliations": [
        "University College London Institute for Liver and Digestive Health, London, UK",
        "Hepatology and Liver Transplantation, Royal Free London NHS Foundation Trust, London, UK"
      ],
      "name": "Kohi Gananandan"
    },
    {
      "affiliations": [
        "Liver Failure Group, University College London Institute for Liver and Digestive Health, London, UK"
      ],
      "name": "Alexandra Phillips"
    },
    {
      "affiliations": [
        "Liver Failure Group, University College London Institute for Liver and Digestive Health, London, UK",
        "Internal Medicine Department, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal"
      ],
      "name": "Rita Bragança"
    },
    {
      "affiliations": [
        "Liver Failure Group, University College London Institute for Liver and Digestive Health, London, UK",
        "Internal Medicine Department, Unidade Local de Saúde de Trás-os-Montes e Alto Douro, Vila Real, Portugal"
      ],
      "name": "Mariana Esteves"
    },
    {
      "affiliations": [
        "Liver Failure Group, University College London Institute for Liver and Digestive Health, London, UK"
      ],
      "name": "Sina Jameie-Oskooei"
    },
    {
      "affiliations": [
        "Tropical Medicine Department, Mansoura University Faculty of Medicine, Mansoura, Dakahlia Governorate, Egypt"
      ],
      "name": "Raghda Farag"
    },
    {
      "affiliations": [
        "Tropical Medicine Department, Mansoura University Faculty of Medicine, Mansoura, Dakahlia Governorate, Egypt"
      ],
      "name": "Ahmed Abdel-Razik"
    },
    {
      "affiliations": [
        "Gastrointestinal Surgical Center, Mansoura University Faculty of Medicine, Mansoura, Dakahlia Governorate, Egypt"
      ],
      "name": "Mohamed Abdelwahab"
    },
    {
      "affiliations": [
        "Clinical Immunology Unit, Clinical Pathology Department & Mansoura Research Center for Cord Stem Cell (MARC_CSC), Mansoura University Faculty of Medicine, Mansoura, Dakahlia Governorate, Egypt"
      ],
      "name": "Youssef M Mosaad"
    },
    {
      "affiliations": [
        "Liver Failure Group, University College London Institute for Liver and Digestive Health, London, UK",
        "Aarhus University Hospital Department of Hepatology and Gastroenterology, Aarhus, Denmark"
      ],
      "name": "Rajeshwar P Mookerjee"
    },
    {
      "affiliations": [
        "Liver Failure Group, University College London Institute for Liver and Digestive Health, London, UK",
        "Hepatology and Liver Transplantation, Royal Free London NHS Foundation Trust, London, UK"
      ],
      "name": "Rajiv Jalan"
    }
  ],
  "title": "Resolving the ACLF paradox: discharge hepatic reserve, not admission severity, predicts recovery",
  "uid": "8f72d967-c6d8-588b-8865-01fe0eee969f"
}