Hong Yun Soo, Sinn Dong Hyun, Gwak Geum-Youn, Cho Juhee, Kang Danbee, Paik Yong-Han, Choi Moon Seok, Lee Joon Hyeok, Koh Kwang Cheol, Paik Seung Woon
Yun Soo Hong, Dong Hyun Sinn, Geum-Youn Gwak, Yong-Han Paik, Moon Seok Choi, Joon Hyeok Lee, Kwang Cheol Koh, Seung Woon Paik, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul 06351, South Korea.
World J Gastroenterol. 2016 Apr 14;22(14):3785-92. doi: 10.3748/wjg.v22.i14.3785.
To analyze characteristics and outcome of patients with acute-on-chronic liver failure (ACLF) according to the severity of underlying liver disease.
One hundred and sixty-seven adult patients with chronic liver disease and acute deteriorated liver function, defined by jaundice and coagulopathy, were analyzed. Predisposition, type of injury, response, organ failure, and survival were analyzed and compared between patients with non-cirrhosis (type A), cirrhosis (type B) and cirrhosis with previous decompensation (type C).
The predisposition was mostly hepatitis B in type A, while it was alcoholic liver disease in types B and C. Injury was mostly hepatic in type A, but was non-hepatic in type C. Liver failure, defined by CLIF-SOFA, was more frequent in types A and B, and circulatory failure was more frequent in type C. The 30-d overall survival rate (85.3%, 81.1% and 83.7% for types A, B and C, respectively, P = 0.31) and the 30-d transplant-free survival rate (55.9%, 65.5% and 62.5% for types A, B and C, respectively P = 0.33) were not different by ACLF subtype, but 1-year overall survival rate were different (85.3%, 71.7% and 58.7% for types A, B and C, respectively, P = 0.02).
There were clear differences in predisposition, type of injury, accompanying organ failure and long-term mortality according to spectrum of chronic liver disease, implying classifying subtype according to the severity of underlying liver disease is useful for defining, clarifying and comparing ACLF.
根据基础肝病的严重程度分析慢加急性肝衰竭（ACLF）患者的特征及预后。
分析167例患有慢性肝病且肝功能急性恶化（以黄疸和凝血功能障碍为定义）的成年患者。对非肝硬化患者（A型）、肝硬化患者（B型）和既往有失代偿的肝硬化患者（C型）的易患因素、损伤类型、反应、器官衰竭及生存率进行分析和比较。
A型患者的易患因素大多为乙型肝炎，而B型和C型患者为酒精性肝病。A型患者的损伤大多为肝脏损伤，但C型患者为非肝脏损伤。根据CLIF-SOFA定义的肝衰竭在A型和B型患者中更常见，而循环衰竭在C型患者中更常见。ACLF各亚型的30天总生存率（A型、B型和C型分别为85.3%、81.1%和83.7%，P = 0.31）和30天无移植生存率（A型、B型和C型分别为55.9%、65.5%和62.5%，P = 0.33）无差异，但1年总生存率有差异（A型、B型和C型分别为85.3%、71.7%和58.7%，P = 0.02）。
根据慢性肝病的范围，在易患因素、损伤类型、伴随的器官衰竭和长期死亡率方面存在明显差异，这意味着根据基础肝病的严重程度对亚型进行分类有助于定义、阐明和比较ACLF。
