Acute on chronic liver failure (ACLF) during COVID-19;single UK based hospital experience

Gadour, E.; Agu, D.; Musharaf, M.; Askar, A.; Dixson, M.; Arabiyat, A.; Hassan, A.; Hassan, Z.

Introduction In patients with known liver disease, acute decompensation in association with organ failure due to acute liver insult is known as Acute on Chronic Liver Failure (ACLF).1 We aim to identify and assess the presence of ACLF during the first COVID-19 wave and the main insulting agent. Methodology We retrospectively assessed all patients who had been admitted to our hospital with liver pathology between January 2020 to Jun 2020. Blood tests, radiological imagines, histological results, and endoscopy reports were electronically retrieved. Patients were divided using Child-Pugh liver cirrhosis scoring, MELD and UKELD.2 Fisher's test, Chi-square and SPSS used in data analysis. Results Total number of liver admissions 194 during the study period of 2020. 145 were males (74.74%) and 25.2% were females (n=49) with 156 patients above fifty years (80.41%) (p= 0.0028). Thirty-three of them had variceal bleeding (n=17) and sixty-two had normal gastroscopy (31.9%) whereases ninety-nine did not have gastroscopy (OR=1.61;95%CI =1.9;2.852, p= 0.0024). During the study period, 36.08% of the studied individuals had Child- Pugh score of (A and B) (n=70 each) with only fifty-four who had Child-Pugh (C) liver cirrhosis (n=54), p= 0.008. Acute on Chronic Liver Failure (ACLF) was identified in eight patients (4.12%), while ninety-one had decompensated liver disease (46.9%) and (51.4%) had compensated liver cirrhosis (OR=1.05;95%CI=0.51;3.05, p= 0.015). Although 96.9% had Alcoholic hepatitis (n=188) as the cause of ACLF, 3.1% had other causes (p= 0.0019). Interestingly, 7.7% had (MELD score higher than 40) (n=15) and 12.8% had UKELD score of more than 49 (n=25) (OR=2.90;95% CI=3.99, p=.005). Conclusion Few numbers of patients had ACLF during the first COVID-19 wave however majority of them had alcohol hepatitis as main trigger. We recommend a robust community education programme to help reducing this phenomenon especially during the stressful times.