Clinical Profile and Predictors of Hospital Outcomes in Acute-on-chronic Liver Failure

Acute-on-chronic liver failure (ACLF) is a distinct clinical syndrome characterized by acute hepatic deterioration in patients with underlying chronic liver disease and is associated with multiorgan dysfunction and high short-term mortality. In India, alcohol remains the predominant etiology of chronic liver disease, with infectious causes and alcoholic hepatitis being common acute precipitating events. However, clinical profiles and predictors of in-hospital outcomes show variability across populations. This hospital-based observational study included 50 patients diagnosed with ACLF according to the APASL criteria and admitted to Aakash Healthcare Super Speciality Hospital, New Delhi, between February 2024 and January 2026. Detailed clinical evaluation and laboratory investigations were performed at admission. Disease severity was assessed using Child–Turcotte–Pugh, Model for End-Stage Liver Disease (MELD), and MELD-Na scores. Precipitating factors, complications, organ system involvement, and outcomes during hospitalization were documented. Outcomes were categorized as survival with discharge, in-hospital mortality, or referral for liver transplantation. The mean age of patients was 49.96 ± 11.30 years, with a male predominance (84%). Alcohol-related liver disease was the most common underlying etiology (60%). Alcoholic hepatitis (38%) and sepsis (30%) were the leading precipitating events. Jaundice, abdominal distension, and altered sensorium were the most frequent presenting symptoms. Ascites (96%), portal hypertension (92%), and hepatic encephalopathy (78%) were the predominant complications. In-hospital mortality was observed in 46% of patients, while 22% required referral for liver transplantation. Elevated international normalized ratio, serum creatinine, ammonia, lactate, serum potassium levels, and higher MELD and MELD-Na scores were significantly associated with poor outcomes (p < 0.05). Hepatic encephalopathy was the only clinical complication significantly associated with mortality on univariate analysis (p = 0.021). ACLF predominantly affects middle-aged males with alcohol-related chronic liver disease and is associated with high in-hospital mortality. Early identification of high-risk patients and timely escalation of care, including prompt evaluation for liver transplantation, are crucial to improving outcomes.