IntroductionThe hospital mortality rate in low and middle-income countries is much higher than developed countries,thus enhancing the critical and emergency services will reduce rate of mortality. Providing life savingtreatment, continuous monitoring for the critically ill patient survival is defi nitely linked to availabilityand capability of equipment, drugs, medicine and trained personnel. Therefore, the challenges aredetermined and introduce stepwise method to reduce in-hospital mortality.GoalDetermining second level hospital’s capability to provide critical care and suffi ciency of medical supply.Materials and MethodProvince and district hospitals were included in the research and cross-sectional study conducted. Thesecond level hospitals were selected from 9 Provincials hospitals in 4 regions of Mongolia, 5 districthospitals in the capital city of Ulaanbaatar were involved, clustering and randomised in research. Theresearch conducted after obtaining Medical Ethical Committee approval. Statistical analysis usingSPSS-17. Data and some materials were analyzed with Shapiro-Wilk test for assessing the populationis normally distributed.ResultNone of the hospital is able to provide with 24-specialist doctor service in the emergency room and 3 (21,4%) hospitals have available for 24 hours intensive care doctor service.In the emergency settings, capability for FAST ultrasound examination is 8 (57, 1%) hospitals and noneof the hospital is able to provide echocardiography.Even though the number of intensive care bed is 5.6, the number of ventilators of hospitals are 2.5ventilators in 100.000 populations. 1 hospital is equipped with air-oxygen system. 3 (21.4%) of hospitalsare always able to perform central venous catheterization, and only 3 of the hospitals havevet thecapability of non-invasive ventilation. Drug and medicine use for cardiopulmonary resuscitation, availableof atropine and amiodoran were 9 (64.3%) and 5 (35.7%), respectively.Conclusion: None of the intensive care units of hospital, which participated in our research, able toprovide evidence-based emergency care on acutely ill patients.

Background: Acute-on-chronic liver failure (ACLF) is a clinical syndrome seen in patients with decompensated cirrhosis, marked by organ failure and high risk of mortality. In Mongolia, liver cirrhosis and chronic liver disease are among the leading causes of death, with mortality rates four times higher than the global average. Despite this, full data on ACLF in the country remains insufficient. Aim : This study aims to determine the prevalence, etiology, and outcomes of ACLF in patients admitted with acute de compensated liver cirrhosis. Materials and Methods : This retrospective registry study analyzed all hospital admissions at the Mongolia-Japan Hos pital from Jan 1, 2022, to Dec 31, 2024. Definitions from the European Association for the Study of the Liver (EASL) and the Chronic Liver Failure Consortium (EASL-CLIF) were used. Organ failure was assessed using the adapted Chronic Liver Failure-Organ Failure (CLIF-OF) score. Patients with malignancies meeting the Milan criteria were excluded. Results : A total of 83 patients were included, of whom 41% (n=34) met the ACLF criteria. Among ACLF patients, 58.8% were male, with a median age of 52 years. The most common underlying cause of cirrhosis was viral hepatitis B and D. The main triggers for ACLF were infection (50%) and alcoholic hepatitis (20.6%). ACLF grades were as follows: 29.4% for Grade 1, 29.4% for Grade 2, and 41.1% for Grade 3. The overall in-hospital mortality rate was 28.9%, but it was significantly higher in the ACLF group (75%) compared to the non-ACLF group (25%). Mortality rates increased with ACLF grade: 20% for Grade 1, 50% for Grade 2, and 78.6% for Grade 3 (p < 0.00001). Conclusion 1. The prevalence of acute-on-chronic liver failure (ACLF) among patients with decompensated cirrhosis was 41%, with a notably high in-hospital mortality rate of 52.9%. 2. Bacterial infections, rather than hepatic insults, were the leading precipitating factors for ACLF, accounting for 50% of the cases.