Short-Term Mortality and Its Predictors in Alcohol-Related Acute-on-Chronic Liver Failure: A Systematic Review and Meta-Analysis.
- 1Department of Internal Diseases, Astana Medical University, Astana 010000, Kazakhstan.
- 2Department of Pediatric Diseases, Astana Medical University, Astana 010000, Kazakhstan.
- 3Department of Natural Sciences, West Kazakhstan Marat Ospanov Medical University, Aktobe 030019, Kazakhstan.
Abstract
Background/Objectives: Alcohol-related acute-on-chronic liver failure (ACLF) carries high early mortality, but prognostic evidence varies by definition, endpoint, and adjustment. We estimated short-term mortality and synthesized clinically useful predictors. Methods: PubMed/MEDLINE, Scopus, and Web of Science were searched to 25 June 2026 and, with a revised strategy, to 28 September 2026. Direct alcohol-related ACLF cohorts formed the core evidence base. Mortality was pooled using REML random-effects models with Hartung-Knapp confidence intervals and 95% prediction intervals (PIs); predictors were synthesized qualitatively. Risk of bias and certainty were assessed with QUIPS and GRADE. Results: Forty reports (35 independent cohorts) were included. Pooled mortality was 36.0% at 28/30 days (11 cohorts; 95% CI 28.9-43.8; PI 17.3-60.3%) and 50.2% at 90 days (11 cohorts; 95% CI 39.5-60.8; PI 19.2-81.0%), without significant differences between APASL/AARC- and EASL-CLIF-defined cohorts. Qualitatively, organ-failure burden, infection or sepsis, hepatic encephalopathy, renal dysfunction, shock, and higher MELD-, CLIF-, or AARC-based severity were the most consistent adverse signals; pooled predictor effects could not be estimated. Conclusions: About one-third of patients die by 28/30 days and half by 90 days, but mortality varies widely across settings. Predominantly very low-certainty predictor evidence supports framework-appropriate scores and repeated assessment rather than a universal cutoff.
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BibTeX
@article{sapanova2026shortterm,
title = {{Short-Term Mortality and Its Predictors in Alcohol-Related Acute-on-Chronic Liver Failure: A Systematic Review and Meta-Analysis.}},
author = {Ayauzhan A Sapanova and Venera S Rakhmetova and Assylzhan M Messova and Amin Tamadon and Sagira T Abdrakhmanova},
journal = {Healthcare (Basel, Switzerland)},
year = {2026},
month = oct,
doi = {10.3390/healthcare14203543},
url = {https://europepmc.org/article/MED/42940592},
note = {CC BY},
}
RIS
TY - JOUR
TI - Short-Term Mortality and Its Predictors in Alcohol-Related Acute-on-Chronic Liver Failure: A Systematic Review and Meta-Analysis.
AU - Ayauzhan A Sapanova
AU - Venera S Rakhmetova
AU - Assylzhan M Messova
AU - Amin Tamadon
AU - Sagira T Abdrakhmanova
PY - 2026
DA - 2026/10/21
JO - Healthcare (Basel, Switzerland)
DO - 10.3390/healthcare14203543
UR - https://europepmc.org/article/MED/42940592
AB - Background/Objectives: Alcohol-related acute-on-chronic liver failure (ACLF) carries high early mortality, but prognostic evidence varies by definition, endpoint, and adjustment. We estimated short-term mortality and synthesized clinically useful predictors. Methods: PubMed/MEDLINE, Scopus, and Web of Science were searched to 25 June 2026 and, with a revised strategy, to 28 September 2026. Direct alcohol-related ACLF cohorts formed the core evidence base. Mortality was pooled using REML random-effects models with Hartung-Knapp confidence intervals and 95% prediction intervals (PIs); predictors were synthesized qualitatively. Risk of bias and certainty were assessed with QUIPS and GRADE. Results: Forty reports (35 independent cohorts) were included. Pooled mortality was 36.0% at 28/30 days (11 cohorts; 95% CI 28.9-43.8; PI 17.3-60.3%) and 50.2% at 90 days (11 cohorts; 95% CI 39.5-60.8; PI 19.2-81.0%), without significant differences between APASL/AARC- and EASL-CLIF-defined cohorts. Qualitatively, organ-failure burden, infection or sepsis, hepatic encephalopathy, renal dysfunction, shock, and higher MELD-, CLIF-, or AARC-based severity were the most consistent adverse signals; pooled predictor effects could not be estimated. Conclusions: About one-third of patients die by 28/30 days and half by 90 days, but mortality varies widely across settings. Predominantly very low-certainty predictor evidence supports framework-appropriate scores and repeated assessment rather than a universal cutoff.
SN - 2227-9032
ER -