Reversibility of acute‐on‐chronic liver failure syndrome in hepatitis B virus‐infected patients with and without prior decompensation

Acute‐on‐chronic liver failure (ACLF) is a severe clinical syndrome associated with high short‐term mortality and reversibility. This study aimed to compare the characteristics of survival and reversibility in hepatitis B virus (HBV)‐related ACLF (HBV‐ACLF) patients with and without previous decompensation. Overall, 1044 patients who fulfilled the acute hepatic insult criteria of the APASL‐ACLF Research Consortium (AARC) definition were enrolled from a prospectively established cohort of HBV‐related liver failure patients. These patients were divided into the AARC ACLF group and the non‐AARC ACLF group according to prior decompensation. Mortality, reversibility of ACLF syndrome, and predicted factors associated with reversibility were evaluated. Liver transplantation‐free mortality of the AARC ACLF group was significantly lower than that of the non‐AARC ACLF group (28 days: 28.2% vs. 40.3%, p = .012; 90 days: 41.7% vs. 65.4%, p