Abstract
BACKGROUND: Acute-on-chronic liver failure (ACLF) is a prevalent complication among cirrhosis patients, whose high mortality is linked to cirrhosis combined with ACLF. Nevertheless, there is a paucity of systematic reviews. This study aimed to illustrate whether cirrhosis is a prognostic factor for ACLF. METHODOLOGY: PubMed, Embase, and Cochrane Library were searched for observational studies that explored the connection between cirrhosis and ACLF prognosis from database inception to January 10, 2025. Pooled relative risk (RR) and 95% confidence interval (CI) were utilized for data analyses. Publication bias was estimated using Egger's tests. The protocol was registered in the PROSPERO (CRD42025639557). RESULTS: This meta-analysis included 17 articles and 8,488 patients of ACLF under different diagnostic criteria. The analyses indicated that cirrhosis did not correlate with 28-day mortality of ACLF patients (RR = 1.08, 95% CI [0.84-1.39], p = 0.550, I(2) = 88.8%) but independently predicted 90-day mortality (RR = 1.33, 95% CI [1.10-1.61], p = 0.004, I (2) = 92.6%). Subgroup analyses of cirrhosis discovered no significant difference in 28-day and 90-day mortality between non-cirrhosis patients and those with compensated cirrhosis (p > 0.05). The 90-day mortality in decompensated cirrhosis patients was markedly higher than that in non-cirrhosis individuals (RR = 1.33, 95% CI [1.14-1.56], p < 0.001, I(2) =64.2%). CONCLUSIONS: Compensated cirrhosis did not correlate with the 28-day mortality of ACLF patients, while it was an independent risk factor for 90-day mortality.