{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T01:31:48Z","timestamp":1773451908465,"version":"3.50.1"},"reference-count":15,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T00:00:00Z","timestamp":1644192000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T00:00:00Z","timestamp":1644192000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"funder":[{"name":"Thai Association for the Study of the Liver"},{"name":"The Gastroenterological Association of Thailand"},{"name":"National Health Security Office"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Health Serv Res"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec>\n                <jats:title>Background<\/jats:title>\n                <jats:p>Accurate population-based data are required concerning the rate, economic impact, and long-term outcome from acute on chronic liver failures (ACLF) in hospitalized patients with cirrhosis.<\/jats:p>\n                <jats:p>We aimed to discover time trends for the epidemiology, economic burden, and mortality of ACLF in Thailand.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Methods<\/jats:title>\n                <jats:p>We conducted a nationwide, population-based, cohort study which involved all hospitalized patients with cirrhosis in Thailand during the period between 2009 and 2013, with data from the National Health Security Office. ACLF was defined by two or more extrahepatic organ failures in patients with cirrhosis. Primary outcomes were trends in hospitalizations, hospital costs, together with inpatient mortality.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Results<\/jats:title>\n                <jats:p>The number of ACLF hospitalizations in Thailand doubled between 3185 in 2009 and 7666 in 2013. The average cost of each ACLF hospitalization was 3.5-fold higher than for cirrhosis ($ 1893 versus $ 519). The hospital is paid using a diagnosis-related group (DRG) payment system that is only 15% of the average treatment costs ($ 286 from $ 1893). The in-hospital fatality rate was 51% for ACLF while the additional fatality rate was 85% up to 1\u2009year. The ACLF organ failure trends indicated sepsis with septic shock and renal failure as the majority proportion. Age, the number and types of organ failure and male sex were predictors of ACLF death.<\/jats:p>\n              <\/jats:sec><jats:sec>\n                <jats:title>Conclusions and relevance<\/jats:title>\n                <jats:p>Cirrhosis and ACLF both represent substantial and increasing health and economic burdens for Thailand. These data can assist national health care policy stakeholders to target high-risk patients with cirrhosis for care.<\/jats:p>\n              <\/jats:sec>","DOI":"10.1186\/s12913-022-07574-6","type":"journal-article","created":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T04:13:47Z","timestamp":1644207227000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Health care burden and mortality of acute on chronic liver failure in Thailand: a nationwide population-based cohort study"],"prefix":"10.1186","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6924-8504","authenticated-orcid":false,"given":"Sakkarin","family":"Chirapongsathorn","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kittiyod","family":"Poovorawan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ngamphol","family":"Soonthornworasiri","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wirichada","family":"Pan-ngum","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Amnart","family":"Chaiprasert","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kamthorn","family":"Phaosawasdi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sombat","family":"Treeprasertsuk","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,2,7]]},"reference":[{"key":"7574_CR1","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1016\/j.jhep.2018.09.014","volume":"70","author":"SK Asrani","year":"2019","unstructured":"Asrani SK, Devarbhavi H, Eaton J, et al. Burden of liver diseases in the world. J Hepatol. 2019;70:151\u201371.","journal-title":"J Hepatol"},{"key":"7574_CR2","doi-asserted-by":"publisher","unstructured":"GBD 2017 Cirrhosis Collaborators. The global, regional, and national burden of cirrhosis by cause in 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017. Lancet Gastroenterol Hepatol. 2020;5(3):245\u201366.\u00a0https:\/\/doi.org\/10.1016\/S2468-1253(19)30349-8.","DOI":"10.1016\/S2468-1253(19)30349-8"},{"key":"7574_CR3","doi-asserted-by":"publisher","first-page":"e00062","DOI":"10.14309\/ctg.0000000000000062","volume":"10","author":"AP Desai","year":"2019","unstructured":"Desai AP, Mohan P, Nokes B, et al. Increasing economic burden in hospitalized patients with cirrhosis: analysis of a national database. Clin Transl Gastroenterol. 2019;10:e00062.","journal-title":"Clin Transl Gastroenterol"},{"key":"7574_CR4","doi-asserted-by":"publisher","first-page":"453","DOI":"10.1002\/hep4.1472","volume":"4","author":"S Chirapongsathorn","year":"2020","unstructured":"Chirapongsathorn S, Poovorawan K, Soonthornworasiri N, et al. Thirty-day readmission and cost analysis in patients with cirrhosis: a nationwide population-based data. Hepatol Commun. 2020;4:453\u201360.","journal-title":"Hepatol Commun"},{"key":"7574_CR5","doi-asserted-by":"publisher","first-page":"1287","DOI":"10.1038\/ajg.2017.175","volume":"112","author":"F Kanwal","year":"2017","unstructured":"Kanwal F, Tansel A, Kramer JR, et al. Trends in 30-day and 1-year mortality among patients hospitalized with cirrhosis from 2004 to 2013. 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Survival in infection-related acute-on-chronic liver failure is defined by extrahepatic organ failures. Hepatology. 2014;60:250\u20136.","journal-title":"Hepatology"},{"key":"7574_CR9","doi-asserted-by":"publisher","first-page":"461","DOI":"10.1007\/s12072-017-9816-z","volume":"11","author":"A Choudhury","year":"2017","unstructured":"Choudhury A, Jindal A, Maiwall R, et al. Liver failure determines the outcome in patients of acute-on-chronic liver failure (ACLF): comparison of APASL ACLF research consortium (AARC) and CLIF-SOFA models. Hepatol Int. 2017;11:461\u201371.","journal-title":"Hepatol Int"},{"key":"7574_CR10","doi-asserted-by":"publisher","first-page":"188","DOI":"10.1002\/hep4.1137","volume":"2","author":"S Chirapongsathorn","year":"2018","unstructured":"Chirapongsathorn S, Krittanawong C, Enders FT, et al. Incidence and cost analysis of hospital admission and 30-day readmission among patients with cirrhosis. 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J Gastroenterol Hepatol. 2021;36: 27\u201343. https:\/\/doi.org\/10.1111\/jgh.15604.","DOI":"10.1111\/jgh.15604"}],"container-title":["BMC Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-022-07574-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12913-022-07574-6\/fulltext.html","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12913-022-07574-6.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,2,7]],"date-time":"2022-02-07T16:23:52Z","timestamp":1644251032000},"score":1,"resource":{"primary":{"URL":"https:\/\/bmchealthservres.biomedcentral.com\/articles\/10.1186\/s12913-022-07574-6"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,2,7]]},"references-count":15,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2022,12]]}},"alternative-id":["7574"],"URL":"https:\/\/doi.org\/10.1186\/s12913-022-07574-6","relation":{},"ISSN":["1472-6963"],"issn-type":[{"value":"1472-6963","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,2,7]]},"assertion":[{"value":"16 September 2021","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"1 February 2022","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"7 February 2022","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"This study was carried out according to the principles expressed in the Declaration of Helsinki and was approved by the Gastroenterological Association of Thailand in collaboration with the National Health Security Office, Thailand. All data were de-identified and released for research purposes therefore the consent form was not performed. The research protocol was approved by the Institutional Review Board of the Faculty of Tropical Medicine, Mahidol University (MUTM 2014-056-01).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable. No details, images, or videos relating to individual participants are included in the manuscript.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"156"}}