Division of Critical Care Medicine, Mayo Clinic, Rochester, Minnesota, USA.
Curr Opin Crit Care. 2011 Apr;17(2):165-9. doi: 10.1097/MCC.0b013e328344b42d.
A population of patients with previously compensated cirrhosis will develop acute deterioration resulting in multiorgan failure and high short-term mortality. Complications of cirrhosis frequently culminate in admissions to the ICU. This review advances the concept of acute-on-chronic liver failure as a distinct clinical entity.
Recently, the American Association for the Study of Liver Disease and the European Association for the Study of the Liver created a research consortium to advance the state of the science of acute-on-chronic liver failure. The goal of this consortium is aimed at improving outcomes, identification of a subset of patients with cirrhosis at high risk for deterioration, and the inciting events that lead to this deterioration. Liver transplant remains the only curative option for advanced cirrhosis; however, the limited number of available organs necessitates innovations in the care of advanced liver disease. Liver replacement therapies have not as yet demonstrated reduction in mortality, but have demonstrated improvements in other measures. Large-scale prospective studies of cirrhosis are required.
Acute-on-chronic liver failure may be a distinct clinical entity with a potential for reversibility when identified early and managed with aggressive critical care support.
先前代偿性肝硬化患者的一部分会出现急性恶化，导致多器官衰竭和高短期死亡率。肝硬化的并发症经常导致入住 ICU。本综述提出了慢性肝衰竭急性发作作为一个独特的临床实体的概念。
最近，美国肝脏病研究协会和欧洲肝脏病研究协会成立了一个研究联盟，旨在推进慢性肝衰竭急性发作的科学研究。该联盟的目标是改善预后，确定肝硬化患者中处于高危恶化风险的亚组，以及导致这种恶化的激发事件。肝移植仍然是晚期肝硬化的唯一治愈方法；然而，可用器官的数量有限，需要对晚期肝病的护理进行创新。肝脏替代疗法尚未证明能降低死亡率，但已证明能改善其他指标。需要对肝硬化进行大规模的前瞻性研究。
当早期发现并通过积极的重症监护支持进行治疗时，慢性肝衰竭急性发作可能是一种独特的临床实体，具有潜在的可逆性。
