Pancreatic involvement and its prognostic impact in acute-on-chronic liver failure

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INTRODUCTION AND OBJECTIVES: Acute-on-chronic liver failure (ACLF) in cirrhotic patients is marked by a multiorgan failure and high mortality. The role of the pancreas in ACLF is poorly understood. This study evaluated the prevalence, progression and prognostic impact of elevated lipase (eLIP) and amylase (eAMY) in ACLF. PATIENTS AND METHODS: We retrospectively analyzed ACLF patients (EASL-CLIF criteria) at the Vienna General Hospital (11/2003-11/2022). eLIP and eAMY were defined as levels ≥3 times the upper limit of normal. Data were collected before ACLF onset, at diagnosis (D0), and on days 7 (D7), 28 (D28), and 90 (D90) post-diagnosis. Factors associated with eLIP were identified using univariable logistic regression, and survival was examined with uni- and adjusted multivariable Cox regression models. RESULTS: Among 193 patients, D28 and D90 mortalities were 39.9% and 53.9%, respectively. At D0, lipase and (alpha-)amylase elevations were found in 43.5% and 50.2% of patients, with strong correlation (Spearman's rho: 0.687; p<0.001). eLIP was observed in 8.8% at D0 and 15.7% at D7. At D0, impaired circulation (MAP <70 mmHg, odds ratio [OR] 4.41; p=0.048) and kidney failure (OR 6.31; p=0.030) were linked to eLIP, and circulatory failure at D0 (OR 3.30; p=0.012) to D7 eLIP. Although D0 enzyme levels did not prognosticate mortality, eLIP at D7 independently predicted D28 (adjusted hazard ratio [aHR]: 2.15; p=0.031) and D90 mortality (aHR 2.14; p=0.011). CONCLUSIONS: Increased lipase and (alpha-)amylase levels are common in ACLF. Notably, lipase levels ≥3x ULN at ACLF-D7 predict mortality independent from liver function, suggesting a role in disease progression.

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