Department of Hepatology, Institute of Liver & Biliary Sciences (ILBS), New Delhi, India; Department of Gastroenterology, GB Pant Hospital, New Delhi, India.
J Gastroenterol Hepatol. 2013 Aug;28(8):1361-7. doi: 10.1111/jgh.12191.
Acute-on-chronic liver failure (ACLF) is a clinical entity where there is a potential for reversibility of hepatic dysfunction once the acute hepatic insult resolves. The portal and systemic hemodynamics in ACLF patients to study its relevance in determining the clinical outcomes was studied.
Clinical, laboratory, portal, and systemic hemodynamic assessments were done at admission and after 3 months. Standard medical care was given to all the patients.
Fifty-seven patients with ACLF were enrolled, and they underwent baseline hepatic venous pressure gradient (HVPG) measurement. Twenty-six (46%) patients died during the 3-month follow-up. Presence of high HVPG and hepatic encephalopathy were found to be independent baseline predictors of mortality. Of the 31 surviving patients, 24 consented for a repeat HVPG. The baseline HVPG reduced from 16 (range 12-30) to 13 (range 6-21) mmHg; (P < 0.05). The reduction in HVPG correlated with clinical and biochemical recovery, and reduction in Child-Turcotte-Pugh score score (P < 0.05), while the aortic mean arterial pressure, cardiac index and systemic vascular resistance index improved significantly (< 0.05). Six (25%) patients developed upper gastrointestinal bleed; the median HVPG between bleeders and non-bleeders was not different possibly because of early onset of bleed (median 20 [15-45 days]).
Baseline HVPG is an independent predictor of mortality in ACLF patients. The portal and systemic circulatory anomalies regress substantially by 90 days and correlate with clinical recovery. However, in the initial phase, the raised portal pressure predisposes these patients to high risk of variceal bleeding.
慢加急性肝衰竭（ACLF）是一种临床实体，一旦急性肝损伤消退，肝功能障碍有可能逆转。本研究旨在探讨 ACLF 患者的门脉和全身血液动力学变化，并研究其在确定临床结局中的相关性。
在入院时和 3 个月后进行临床、实验室、门脉和全身血液动力学评估。所有患者均接受标准医疗护理。
共纳入 57 例 ACLF 患者，并进行了基线肝静脉压力梯度（HVPG）测量。在 3 个月的随访期间，26 例（46%）患者死亡。高 HVPG 和肝性脑病的存在是死亡的独立基线预测因子。在 31 例存活患者中，24 例同意重复 HVPG。基线 HVPG 从 16（范围 12-30）mmHg 降至 13（范围 6-21）mmHg；（P<0.05）。HVPG 的降低与临床和生化恢复相关，与 Child-Turcotte-Pugh 评分降低相关（P<0.05），而主动脉平均动脉压、心指数和全身血管阻力指数显著改善（P<0.05）。6 例（25%）患者发生上消化道出血；出血者和非出血者的 HVPG 中位数无差异，可能是因为出血发生较早（中位数 20 [15-45 天]）。
基线 HVPG 是 ACLF 患者死亡的独立预测因子。门脉和全身循环异常在 90 天内明显消退，并与临床恢复相关。然而，在初始阶段，升高的门脉压使这些患者易发生静脉曲张出血的高风险。
