Short-Term Mortality and Its Predictors in Alcohol-Related Acute-on-Chronic Liver Failure: A Systematic Review and Meta-Analysis

Background/Objectives: Alcohol-related acute-on-chronic liver failure (ACLF) carries high early mortality, but prognostic evidence varies by definition, endpoint, and adjustment. We estimated short-term mortality and synthesized clinically useful predictors.

Methods

PubMed/MEDLINE, Scopus, and Web of Science were searched to 25 June 2026 and, with a revised strategy, to 28 September 2026. Direct alcohol-related ACLF cohorts formed the core evidence base. Mortality was pooled using REML random-effects models with Hartung-Knapp confidence intervals and 95% prediction intervals (PIs); predictors were synthesized qualitatively. Risk of bias and certainty were assessed with QUIPS and GRADE.