{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T03:33:26Z","timestamp":1792035206086,"version":"4.4.0"},"reference-count":36,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T00:00:00Z","timestamp":1638489600000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["Hepatol Commun"],"published-print":{"date-parts":[[2022,5]]},"abstract":"<jats:p>Differences in mortality between critically ill patients with severe alcohol\u2010associated hepatitis (sAH) and acute\u2010on\u2010chronic liver failure (ACLF) and non\u2010sAH ACLF (i.e., ACLF not precipitated by sAH) are unknown. Such differences are important, as they may inform on prognosis and optimal timing of liver transplantation (LT). Thus, we aimed to compare short\u2010term and longer\u2010term mortality between patients with sAH ACLF and patients with non\u2010sAH ACLF who were admitted to the intensive care unit. Patients with ACLF admitted from 2016\u20102018 at two tertiary care intensive care units were analyzed. SAH was defined by the National Institute on Alcohol Abuse and Alcoholism\u2019s Alcoholic Hepatitis Consortium and Model for End\u2010Stage Liver Disease score &gt;20. Mortality without LT was compared between sAH ACLF and non\u2010sAH ACLF using Fine and Gray\u2019s competing\u2010risks regression. A total of 463 patients with ACLF (18% sAH and 82% non\u2010sAH) were included. Compared to patients with non\u2010sAH ACLF, patients with sAH ACLF were younger (49 vs. 56\u00a0years; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001) and had higher admission Model for End\u2010Stage Liver Disease (MELD) (35 vs. 25; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001) and Chronic Liver Failure Consortium (CLIF\u2010C) scores (61 vs. 57; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.002). There were no significant differences between the two groups for vasopressor, mechanical ventilation, and hemodialysis use. The cumulative incidence of death was significantly higher in patients with sAH ACLF compared to patients with non\u2010sAH ACLF: 30\u2010day 74.7% versus 45.3%; 90\u2010day 81.9% versus 57.4%; 180\u2010day 83.2% versus 63.0% (unadjusted subdistribution hazard ratio [sHR] 1.88 [95% confidence interval (CI) 1.44\u20102.46]; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0&lt;\u00a00.001). After adjusting for CLIF\u2010C score and infection in a multivariable competing\u2010risk model, patients with sAH ACLF had significantly higher risk of death (sHR 1.57 [95% CI 1.20\u20102.06]; <jats:italic toggle=\"yes\">P<\/jats:italic>\u00a0=\u00a00.001) compared to patients with non\u2010sAH ACLF. <jats:italic toggle=\"yes\">Conclusion:<\/jats:italic> Critically ill patients with sAH ACLF have worse mortality compared to patients with non\u2010sAH ACLF. These data may inform prognosis in patients with sAH and ACLF, and early LT referral in potentially eligible patients.<\/jats:p>","DOI":"10.1002\/hep4.1874","type":"journal-article","created":{"date-parts":[[2021,12,3]],"date-time":"2021-12-03T13:51:26Z","timestamp":1638539486000},"page":"1090-1099","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":18,"title":["Severe Alcohol\u2010Associated Hepatitis Is Associated With Worse Survival in Critically Ill Patients With Acute on Chronic Liver Failure"],"prefix":"10.1097","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3633-382X","authenticated-orcid":false,"given":"Kavish R.","family":"Patidar","sequence":"first","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Indiana University School of Medicine,Indianapolis,IN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jennifer L.","family":"Peng","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Indiana University School of Medicine,Indianapolis,IN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harleen","family":"Kaur","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine,Indiana University School of Medicine,Indianapolis,IN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Astin","family":"Worden","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine,Indiana University School of Medicine,Indianapolis,IN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carla D.","family":"Kettler","sequence":"additional","affiliation":[{"name":"Department of Biostatistics,Indiana University School of Medicine,Indianapolis,IN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francis","family":"Pike","sequence":"additional","affiliation":[{"name":"Department of Biostatistics,Indiana University School of Medicine,Indianapolis,IN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Caitriona A.","family":"Buckley","sequence":"additional","affiliation":[{"name":"Division of Pulmonology and Critical Care,Indiana University School of Medicine,Indianapolis,IN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric S.","family":"Orman","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Indiana University School of Medicine,Indianapolis,IN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Archita P","family":"Desai","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Indiana University School of Medicine,Indianapolis,IN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0837-0746","authenticated-orcid":false,"given":"Lauren D.","family":"Nephew","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Indiana University School of Medicine,Indianapolis,IN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chandrashekhar A.","family":"Kubal","sequence":"additional","affiliation":[{"name":"Division of Transplant Surgery,Indiana University School of Medicine,Indianapolis,IN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2056-4909","authenticated-orcid":false,"given":"Samer","family":"Gawrieh","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Indiana University School of Medicine,Indianapolis,IN,USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naga","family":"Chalasani","sequence":"additional","affiliation":[{"name":"Division of Gastroenterology and Hepatology,Indiana University School of 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