Patrick S. Kamath, MD, DM, MBBS, is one of a handful of researchers worldwide who decided more than a decade ago to begin to research acute on chronic liver failure more closely, making him a natural fit to deliver Tuesday’s Leon Schiff State-of-the-Art Lecture, “Acute on Chronic Liver Failure.”
Acute on chronic liver failure is a syndrome that occurs in patients with chronic liver disease with or without previously diagnosed cirrhosis. The condition is characterized by acute hepatic decompensation resulting in liver failure, with one or more extrahepatic organ failures.
“Acute on chronic liver failure is not a new condition, but it is beginning to be more widely recognized,” said Dr. Kamath, consultant in gastroenterology and hepatology at Mayo Clinic, Rochester, Minn.
That is because the prevalence of acute on chronic liver failure, especially in the United States, is increasing. Recent research estimates that there are about 700,000 cirrhosis hospitalizations a year in the United States, and more than 32,000 of those are due to acute on chronic liver failure.
“This rate has risen six times over in the last decade,” Dr. Kamath said. “And, more important than that is that about 50% of patients will die of this condition within three months.”
Acute on chronic liver failure also has a large effect on health care costs. In 2011, the condition was estimated to cost the health care industry about $1.7 billion. Each hospitalization for acute on chronic liver failure is estimated to cost about $52,000 compared with a cost of around $15,000 for hospitalization for cirrhosis. The mean length of hospital stay for patients with acute on chronic liver failure is 16 days, compared with about five days for pneumonia or congestive heart failure, and nine days for sepsis.
“These patients are very sick. The disease is very expensive, and mortality is decreasing but is still unexpectedly high,” Dr. Kamath said.
During his lecture, Dr. Kamath will discuss how acute on chronic liver failure is best defined and the pathophysiology of the condition. Several precipitating factors have been linked with acute on chronic liver failure, he noted.
“In the West, it is more alcoholic hepatitis superimposed on liver disease,” Dr. Kamath explained. “In Asia, it can be alcohol-related but it is more likely hepatitis B reactivation which causes the condition.”
Dr. Kamath will also highlight how infection is involved in the condition, and why there is often extrahepatic organ failure. In addition, he will discuss the use of treatments for the condition including liver support devices and the role of early liver transplantation.
According to Dr. Kamath, acute on chronic liver failure is something every clinician should be familiar with.
“Most patients with cirrhosis who are in the intensive care unit very likely have acute on chronic liver failure,” he said.
After his lecture, he hopes attendees will have a better understanding of just how sick this population of patients is and how best to approach their treatment.