cardiovascular (OR 16.5), pulmonary (13.5%) and HE grade 2 or more (OR 10.5). Conclusion: ACLF is a presentation in 10% of child- hood CLD. Acute events are mostly a flare of the disease, viral infections and drugs. 39% patients die or require LT. Presence of 2 or more organ failures, higher CTP, CLIF-SOFA and APACHE are good pre- dictors of mortality in children with ACLF. Table 1 Etiology of Acute-on-Chronic Liver Failure. Etiology of chronic liver disease Acute event N (%) Wilson’s disease (n = 19) Flare 11 HAV + HEV 3+2 CAM + ATT 2+1 AIH (n = 11) Flare 7 HAV 1 HEV + EBV 2+1 Cryptogenic and HVOTO (n = 5 + 1) Unknown 3 HEV/HAV 2 Cam + ATD 1 Biliary atresia (n = 2) HEV 1 SBP 2 HBV (n = 2) Reactivation 2 Corresponding author: Bikrant Lal. E-mail: bikrant18may@gmail.com http://dx.doi.org/10.1016/j.jceh.2015.07.254 CLINICAL PROFILE AND OUTCOME IN ACUTE ON CHRONIC LIVER FAILURE (ACLF) Sanchit Budhiraja, Ashok Jain, Vinod Dixit, Sunit Shukla, Ashish Mehta, Pankaj Asati, Manish Tripathi, Manas Behera, B. Abhilash Institute of Medical Sciences, BHU, Varanasi, India Background and Aims: ACLF is defined as an acute deterioration of liver function in a patient with pre- viously fairly well-compensated chronic liver disease. The aims of this study were to understand the natural history, etiology of acute insult and underlying chronic liver disease, prognostic outcome, and whether there was any subgroup of chronic liver disease which had a higher rate of decompensation. Materials and Methods: This was a prospective study conducted in the Gastroenterology depart- ment, Institute of Medical Sciences, BHU, Varanasi from December 2013 to November 2014. Data including demographics, clinical presentation, hospi- tal course and outcome of 86 patients were recorded. The etiologies of superimposed acute event and chronic liver disease were investigated on the basis of routine investigations, viral markers, autoimmune markers, Wilson disease panel, serum ferritin and liver biopsy (if feasible). Study variables like coagulo- pathy, hepatic encephalopathy, sepsis, hyponatremia, renal failure, hepatorenal syndrome and various prognostic scores were considered. Results: Most of the patients were young adults (55%) and males were more common than females (M: F = 2.7:1). The most common presenting features were coagulopathy and ascites (95%) whereas ence- phalopathy (28%) and GI bleed were less common. The most common cause of acute insult leading to Fig. 1 Etiology of acute events. Table 1 Comparison of Hematological and Biochemical Parameters between Survivors and Nonsurvivors. Variable Survivors (n = 45) Nonsurvivors (n = 36) P-value TLC (Â10 9 /L, median, Q1–Q3) 8.4 (3.2–18.9) 15.0 (2.5–37.2) <0.0001 Total bilirubin (mg/dl, mean Æ SD) 17.7 Æ 9.8 22.6 Æ 9.8 0.02 ALT (IU/L, median, Q1–Q3) 143 (73–387) 163 (79–257) NS Serum albumin (g/dl, mean Æ SD) 2.96 Æ 0.67 2.65 Æ 0.43 0.01 INR (mean Æ SD) 1.76 Æ 0.43 2.57 Æ 0.91 <0.01 Serum creatinine (mg/dl, mean Æ SD) 0.8 Æ 0.32 1.7 Æ 1.3 <0.0001 ACUTE LIVER FAILURE AND ACUTE ON CHRONIC LIVER FAILURE S10 © 2015, INASL ALF and ACLF