Agrawal Swastik, Duseja Ajay, Gupta Tarana, Dhiman Radha K, Chawla Yogesh
Department of Hepatology, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
J Gastroenterol Hepatol. 2015 Mar;30(3):575-81. doi: 10.1111/jgh.12778.
This study assessed the utility of a simple organ failure count (SOFC) in predicting the in-hospital mortality in patients with acute-on-chronic liver failure (ACLF) compared with Chronic Liver Failure Acute-on-Chronic Liver Failure in Cirrhosis (CANONIC) ACLF grading system.
Consecutive patients of ACLF were included prospectively from 2012 to 2013. The diagnosis was based on Asian-Pacific Association for the Study of the Liver (APASL) criteria except for the inclusion of non-hepatic insults as acute events. Organ failures were defined as per the Chronic Liver Failure-Sequential Organ Failure Assessment system. SOFC was calculated as the simple number of organ failures from 0 to 6. In-hospital mortality was recorded.
Majority (92[87%]) of the 106 patients included were males, had alcohol (76[72%]) as the etiology of cirrhosis, and alcoholic hepatitis (58[55%]) as the acute precipitating event. Overall, 51(48%) patients died in-hospital. In-hospital mortality in patients with SOFC of 0 (n = 9), 1 (n = 39), 2 (n = 24), 3 (n = 24), 4 (n = 7), and 5 (n = 3) was 0%, 26%, 58%, 71%, 100%, and 100% respectively (P < 0.001), whereas it was 10%, 30%, 58%, and 79% in patients with no-ACLF (n = 21), grades 1 (n = 27), 2 (n = 24), and 3 ACLF (n = 34) respectively (P < 0.001). Patients with no-ACLF (n = 21) had higher mortality than SOFC 0 as they included 9 patients with SOFC 0 (0% mortality) and 12 patients with SOFC 1 (17% mortality). Mortality was similar between 12 no-ACLF and 27 grade 1 ACLF patients (P = 0.462) that comprised SOFC 1.
SOFC is a simpler and better method than the CANONIC grading system for predicting the in-hospital mortality in patients with ACLF defined as per APASL criteria.
本研究评估了简单器官衰竭计数（SOFC）在预测慢性肝衰竭急性发作（ACLF）患者院内死亡率方面的效用，并与肝硬化慢性肝衰竭急性发作（CANONIC）ACLF分级系统进行比较。
前瞻性纳入2012年至2013年连续的ACLF患者。诊断基于亚太肝脏研究协会（APASL）标准，但将非肝脏损伤作为急性事件纳入。器官衰竭根据慢性肝衰竭-序贯器官衰竭评估系统定义。SOFC计算为0至6的器官衰竭简单数量。记录院内死亡率。
纳入的106例患者中，大多数（92例[87%]）为男性，肝硬化病因是酒精（76例[72%]），急性诱发事件是酒精性肝炎（58例[55%]）。总体而言，51例（48%）患者院内死亡。SOFC为0（n = 9）、1（n = 39）、2（n = 24）、3（n = 24）、4（n = 7）和5（n = 3）的患者院内死亡率分别为0%、26%、58%、71%、100%和100%（P < 0.001），而无ACLF（n = 21）、1级（n = 27）、2级（n = 24）和3级ACLF（n = 34）患者的院内死亡率分别为10%、30%、58%和79%（P < 0.001）。无ACLF（n = 21）患者的死亡率高于SOFC为0的患者，因为其中包括9例SOFC为0（死亡率0%）和12例SOFC为1（死亡率17%）的患者。12例无ACLF患者和27例1级ACLF患者（构成SOFC为1）的死亡率相似（P = 0.462）。
对于根据APASL标准定义的ACLF患者，SOFC是一种比CANONIC分级系统更简单且更好的预测院内死亡率的方法。
