To the Editor:
I read with great interest the study by Wong and Piano et al.
[1]
In the United States, non-alcoholic fatty liver disease (NAFLD)-related acute-on-chronic liver failure (ACLF) is the second leading cause of transplant listing, while listings for NAFLD-ACLF are outpacing listings for NAFLD without ACLF.[2]
This is particularly noteworthy, since unlike other etiologies of liver disease associated with ACLF, namely alcohol-related liver disease and HBV infection, NAFLD is a disease process without an inherent precipitant such as alcohol use or flare of hepatitis B. Though obesity may pose a risk for ACLF development in the NAFLD population,[3]
the specific reason for ACLF occurrence in this group is likely from an extrahepatic insult, such as bacterial infection.In the current paper by Wong, Piano, and colleagues, the authors analyzed a large multi-national cohort of patients with decompensated cirrhosis, of whom 563 were diagnosed with ACLF either at the time of infection or after infection. A particular strength of this study was the ability to evaluate patients across Europe, North America, South American and India. Among the 563 patients with ACLF, 62 (11%) had a diagnosis of NAFLD. I am therefore hoping the authors can provide a subgroup analysis of bacterial infections associated with NAFLD-related ACLF, including the organism and infection site, categorized according to whether ACLF occurred at the time of infection or developed after the initial infection. Given the epidemic of NAFLD globally, an analysis of this nature would be of significant use in tailoring strategies for antibiotic prophylaxis.
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The author received no financial support to produce this manuscript.
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Supplementary data
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References
- Clinical features and evolution of bacterial infection-related acute-on-chronic liver failure.J Hepatol. 2021; 74: 330-339
- Acute on chronic liver failure from nonalcoholic fatty liver disease: a growing and aging cohort with rising mortality.Hepatology. 2020; 73: 1932-1944
- Class III obesity is a risk factor for the development of acute-on-chronic liver failure in patients with decompensated cirrhosis.J Hepatol. 2018; 69: 617-625
Article info
Publication history
Published online: April 13, 2021
Accepted:
April 7,
2021
Received:
March 28,
2021
Footnotes
Author names in bold designate shared co-first authorship
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© 2021 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.
