{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T00:14:53Z","timestamp":1787616893432,"version":"build-2736575974"},"reference-count":19,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,11,10]],"date-time":"2025-11-10T00:00:00Z","timestamp":1762732800000},"content-version":"vor","delay-in-days":9,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["JGH Open"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background and Aim<\/jats:title>\n                    <jats:p>Acute\u2010on\u2010chronic liver failure (ACLF) carries high short\u2010term mortality, but real\u2010world evidence under the Japanese ACLF criteria remains limited. We assessed incidence, clinical profile, outcomes, and prognostic factors at a tertiary center in urban Japan.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We retrospectively reviewed 363 consecutive hospitalizations of patients with cirrhosis (2014\u20132022) at a tertiary care center in Japan. ACLF per Japanese criteria was categorized as confirmed (meeting both PT INR\/PT activity and bilirubin thresholds) or extended (meeting either biochemical criterion alone). We pre\u2010specified a parsimonious Cox model with age (per 10\u2009years) and MELD\u2010Na (per 5 points); the primary outcome was time to all\u2010cause death within 90\u2009days (administrative censoring at day 90).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      ACLF occurred in 40\/363 (11.0%) patients (confirmed\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200910, extended\n                      <jats:italic>n<\/jats:italic>\n                      \u2009=\u200930). Frequent precipitants were infection, gastrointestinal bleeding, and alcohol use, often in combination. The 90\u2010day mortality by Kaplan\u2013Meier was 30.5%. Age (per 10\u2009years) was associated with higher 90\u2010day mortality (HR, 2.29; 95% CI 1.31\u20134.00;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01), as was Model for End\u2010Stage Liver Disease including sodium (MELD\u2010Na) (per 5 points) (HR, 1.74; 95% CI 1.16\u20132.63;\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.01).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In this Japanese single center cohort, ACLF (per national criteria) was not rare and carried substantial short\u2010term mortality. Age and MELD\u2010Na were dominant prognostic factors, underscoring early trigger control (notably infection, gastrointestinal bleeding, and alcohol cessation) and timely risk stratification in routine care.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jgh3.70300","type":"journal-article","created":{"date-parts":[[2025,11,11]],"date-time":"2025-11-11T07:12:32Z","timestamp":1762845152000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Incidence and Short\u2010Term Prognosis of Acute\u2010On\u2010Chronic Liver Failure Defined by Japanese Criteria: A Single\u2010Center Retrospective Cohort Study From Urban Japan"],"prefix":"10.1002","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2238-9558","authenticated-orcid":false,"given":"Hidehiro","family":"Kamezaki","sequence":"first","affiliation":[{"name":"Department of Gastroenterology Eastern Chiba Medical Center  Togane Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Terunao","family":"Iwanaga","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Eastern Chiba Medical Center  Togane Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Takahiro","family":"Maeda","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Eastern Chiba Medical Center  Togane Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Junichi","family":"Senoo","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology Eastern Chiba Medical Center  Togane Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6540-9064","authenticated-orcid":false,"given":"Sadahisa","family":"Ogasawara","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shingo","family":"Nakamoto","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Naoya","family":"Kato","sequence":"additional","affiliation":[{"name":"Department of Gastroenterology, Graduate School of Medicine Chiba University  Chiba Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,11,10]]},"reference":[{"key":"e_1_2_11_2_1","doi-asserted-by":"publisher","DOI":"10.1159\/000047017"},{"key":"e_1_2_11_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)00309-8"},{"key":"e_1_2_11_4_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2013.02.042"},{"key":"e_1_2_11_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13066"},{"key":"e_1_2_11_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-014-9580-2"},{"key":"e_1_2_11_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13064"},{"key":"e_1_2_11_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1872-034X.2011.00860.x"},{"key":"e_1_2_11_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.27849"},{"key":"e_1_2_11_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1478-3231.2012.02790.x"},{"key":"e_1_2_11_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/hep.23500"},{"key":"e_1_2_11_12_1","doi-asserted-by":"publisher","DOI":"10.1053\/j.gastro.2014.05.005"},{"key":"e_1_2_11_13_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCC.0b013e328344b42d"},{"key":"e_1_2_11_14_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12072-008-9106-x"},{"key":"e_1_2_11_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/hepr.13763"},{"key":"e_1_2_11_16_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00535-021-01834-8"},{"key":"e_1_2_11_17_1","first-page":"943","article-title":"Hyponatremia and Mortality Among Patients on the Liver\u2010Transplant Waiting List","volume":"358","author":"Kim W. 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