Clinical Features and Natural History of Acute-on-Chronic Liver Failure in Korean Patients With Chronic Liver Disease

Inclusion Criteria: * Chronic liver disease: Chronic hepatitis B, Chronic hepatitis C, Alcoholic liver disease, Biopsy proven or clinically diagnosed liver cirrhosis, Other chronic liver diseases including non-alcoholic fatty liver disease, primary biliary cirrhosis, autoimmune hepatitis, hemochromatosis, Wilson's disease, a-1 antitrypsin deficiency, and cryptogenic causes. * Acute deterioration of liver function: more than one of the below criteria 1. development of new ascites within 4 weeks or re-emergence of ascites who have previous well controlled ascites (greater than or equal to grade 2 or 3; International ascites club criteria) 2. development of hepatic encephalopathy 3. development of gastrointestinal hemorrhage 4. development of jaundice (serum bilirubin greater than or equal to 3mg/dl) 5. development of bacterial infection * spontaneous bacteremia: positive blood cultures without a source of infection * spontaneous bacterial peritonitis: ascitic fluid polymorphonuclear cells \>250/µL * lower respiratory tract infections: new pulmonary infiltrate in the presence of: i) at least one respiratory symptom (cough, sputum production, dyspnea, pleuritic pain) with ii) at least one finding on auscultation (rales or crepitation) or one sign of infection (core body temperature \>38\_C or less than 36\_C, shivering, or leukocyte count \>10,000/mm3 or \<4,000/mm3) in the absence of antibiotics * Clostridium difficile Infection: diarrhea with a positive C. difficile assay * bacterial entero-colitis: diarrhea or dysentery with a positive stool culture for Salmonella, Shigella, Yersinia, Campylobacter, or pathogenic E. coli; * soft-tissue/skin Infection: fever with cellulitis * urinary tract infection (UTI): urine white blood cell \>15/high-power field with either positive urine gram stain or culture; * intra-abdominal infections: diverticulitis, appendicitis, cholangitis, etc. * other infections not covered above; * fungal infections as a separate category. Exclusion Criteria: * Patients who do not have chronic liver disease * Patients who have hepatocellular carcinoma * Patients who admitted for extrahepatic manifestations * Patients who have HIV infection * Patients who admitted for symptomatic control of chronic liver disease, other than acute deterioration of liver function