Wei G, Bergquist A, Broomé U, Lindgren S, Wallerstedt S, Almer S, Sangfelt P, Danielsson A, Sandberg-Gertzén H, Lööf L, Prytz H, Björnsson E
Section of Gastroenterology and Hepatology, Department of Internal Medicine, Sahlgrenska University Hospital, Gothenburg, Sweden.
J Intern Med. 2007 Sep;262(3):393-401. doi: 10.1111/j.1365-2796.2007.01818.x.
To determine the causes and outcome of all patients with acute liver failure (ALF) in Sweden 1994-2003 and study the diagnostic accuracy of King's College Hospital (KCH) criteria and the model for end-stage liver disease (MELD) score with transplant-free deaths as a positive outcome.
Adult patients in Sweden with international normalized ratio (INR) of >or=1.5 due to severe liver injury with and without encephalopathy at admission between 1994-2003 were included.
A total of 279 patients were identified. The most common cause of ALF were acetaminophen toxicity in 42% and other drugs in 15%. In 31 cases (11%) no definite etiology could be established. The KCH criteria had a positive-predictive value (PPV) of 67%, negative-predictive value (NPV) of 84% in the acetaminophen group. Positive-predictive value and negative-predictive value of KCH criteria in the nonacetaminophen group were 54% and 63% respectively. MELD score>30 had a positive-predictive value of 21%, negative-predictive value of 94% in the acetaminophen group. The corresponding figures for the nonacetaminophen group were 64% and 76% respectively.
Acetaminophen toxicity was the most common cause in unselected patients with ALF in Sweden. KCH criteria had a high NPV in the acetaminophen group, and in combination with MELD score<30 predicts a good prognosis in acetaminophen patients without transplantation.
确定1994 - 2003年瑞典所有急性肝衰竭（ALF）患者的病因及预后，并以无移植死亡作为阳性结局研究国王学院医院（KCH）标准和终末期肝病模型（MELD）评分的诊断准确性。
纳入1994 - 2003年瑞典因严重肝损伤入院时国际标准化比值（INR）≥1.5且伴有或不伴有肝性脑病的成年患者。
共确定279例患者。ALF最常见的病因是对乙酰氨基酚中毒，占42%，其他药物占15%。31例（11%）无法确定明确病因。KCH标准在对乙酰氨基酚组的阳性预测值（PPV）为67%，阴性预测值（NPV）为84%。KCH标准在非对乙酰氨基酚组的阳性预测值和阴性预测值分别为54%和63%。MELD评分>30在对乙酰氨基酚组的阳性预测值为21%，阴性预测值为94%。非对乙酰氨基酚组的相应数字分别为64%和76%。
对乙酰氨基酚中毒是瑞典未选择的ALF患者中最常见的病因。KCH标准在对乙酰氨基酚组有较高的NPV，并且与MELD评分<30相结合可预测对乙酰氨基酚中毒患者未经移植的良好预后。
