Single Jaundice in Cirrhosis: A Neglected Acute Decompensation of Acute-on-Chronic Liver Failure and Mortality.

OBJECTIVES

To compare the risk of acute-on-chronic liver failure (ACLF) and short-term outcomes among cirrhotic patients with single jaundice, acute decompensation (AD) (including ascites, variceal bleeding, hepatic encephalopathy, and/or bacterial infection), and non-AD non-jaundice.

METHODS

We analyzed cirrhotic inpatients without obstructive jaundice enrolled from two large multicenter prospective cohorts. Patients were divided at admission into classical AD, single jaundice, or non-AD non-jaundice groups. Baseline characteristics, ACLF development, and short-term outcomes were compared between groups.

RESULTS

Among 2645 cirrhotic patients, classical AD, single jaundice, and non-AD non-jaundice were observed in 2163 (81.78%), 267 (10.09%), and 215 (8.13%), respectively. The 90-day liver transplant (LT)-free mortality was comparable between single jaundice patients and classical AD patients (15.09% vs. 17.81%, p = 0.266), but significantly higher than non-AD non-jaundice patients (2.45%; p < 0.01). The prevalence of ACLF (16.10% vs. 16.09%, p = 1.000) and pre-ACLF (9.36% vs. 6.43%, p = 0.094) were comparable between the single jaundice and classical AD groups. Intrahepatic precipitants, particularly hepatitis B flare with hepatitis B virus (HBV) reactivation (odds ratio [OR] 2.69; p = 0.002), spontaneous hepatitis B flare with high HBV-DNA load (OR 23.75; p < 0.001), superimposed hepatitis A/E virus infection on HBV infection (OR 13.40; p < 0.001) and hepatotoxic drug usage (OR 3.64; p < 0.001) were associated with single jaundice.

CONCLUSIONS

Cirrhotic inpatients with single jaundice show comparably high short-term mortality and ACLF risk to those with classical AD. Single jaundice shall be considered as an AD event and is predominantly triggered by intrahepatic insults, warranting surveillance equivalent to classical AD and prioritized management of the precipitants.