Genetic Ancestry, Race, and Severity of Acutely Decompensated Cirrhosis in Latin America

Genetic ancestry or racial differences in health outcomes exist in diseases associated with systemic inflammation (eg, COVID-19). This study aimed to investigate the association of genetic ancestry and race with acute-on-chronic liver failure (ACLF), which is characterized by acute systemic inflammation, multi-organ failure, and high risk of short-term death. This prospective cohort study analyzed a comprehensive set of data, including genetic ancestry and race among several others, in 1274 patients with acutely decompensated cirrhosis who were nonelectively admitted to 44 hospitals from 7 Latin American countries. Three hundred ninety-five patients (31.0%) had ACLF of any grade at enrollment. Patients with ACLF had a higher median percentage of Native American genetic ancestry and lower median percentage of European ancestry than patients without ACLF (22.6% vs 12.9% and 53.4% vs 59.6%, respectively). The median percentage of African genetic ancestry was low among patients with ACLF and among those without ACLF. In terms of race, a higher percentage of patients with ACLF than patients without ACLF were Native American and a lower percentage of patients with ACLF than patients without ACLF were European American or African American. In multivariable analyses that adjusted for differences in sociodemographic and clinical characteristics, the odds ratio for ACLF at enrollment was 1.08 (95% CI, 1.03–1.13) with Native American genetic ancestry and 2.57 (95% CI, 1.84–3.58) for Native American race vs European American race In a large cohort of Latin American patients with acutely decompensated cirrhosis, increasing percentages of Native American ancestry and Native American race were factors independently associated with ACLF at enrollment. [Display omitted] Acutely decompensated cirrhosis is a rapid deterioration of patient health leading to nonelective hospital admission. Among patients with acutely decompensated cirrhosis, differences in upstream factors, in particular, genetic ancestry (race) may be associated with differences in health outcomes, such as acute-on-chronic liver failure (characterized by the presence of organ failures) and short-term death (ie, death without liver transplantation within 28 days after presentation). To address these questions, the availability of a comprehensive set of data collected in a recently completed prospective cohort of 1274 Latin American patients nonelectively hospitalized for acutely decompensated cirrhosis was lev