Donnelly M C, Davidson J S, Martin K, Baird A, Hayes P C, Simpson K J
Department of Hepatology and Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
Scottish Liver Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK.
Aliment Pharmacol Ther. 2017 Mar;45(6):833-843. doi: 10.1111/apt.13943. Epub 2017 Jan 18.
Acute liver failure is a rare and devastating clinical condition resulting from sudden loss of hepatic parenchyma and metabolic function. The Scottish Liver Transplant Unit (SLTU) offers specialist management and emergency liver transplantation to patients with acute liver failure from across Scotland.
To describe temporal changes in number of admissions, aetiology of acute liver failure, severity of disease at presentation and outcomes over a 22-year period.
Retrospective analysis of the SLTU database, including all patients admitted with acute liver injury or acute liver failure between November 1992 and March 2014.
There has been no change in the number of patients presenting with acute liver injury or failure secondary to paracetamol overdose, but a reduction in the number of admissions with acute liver injury or failure secondary to non paracetamol causes. Over time, disease severity at presentation has not changed in the paracetamol cohort; those with a non paracetamol aetiology have latterly presented with milder hepatic encephalopathy. Spontaneous survival rates improved significantly over time for those patients with acute liver failure due to paracetamol and non paracetamol aetiologies. The most marked improvement in survival is observed in the sickest patients meeting Kings College Hospital poor prognostic criteria.
The number of admissions to the SLTU with acute liver failure is decreasing, due to reduced numbers of non paracetamol cases. Outcomes in this condition are improving, due to improvements in intensive care management and use of liver transplantation, and the increase in survival is most marked in patients meeting Kings College Hospital poor prognostic criteria.
急性肝衰竭是一种罕见且严重的临床病症，由肝实质和代谢功能的突然丧失引起。苏格兰肝移植单位（SLTU）为来自苏格兰各地的急性肝衰竭患者提供专科治疗和紧急肝移植。
描述22年间急性肝衰竭的入院人数、病因、就诊时疾病严重程度及预后的时间变化。
对SLTU数据库进行回顾性分析，纳入1992年11月至2014年3月期间所有因急性肝损伤或急性肝衰竭入院的患者。
对乙酰氨基酚过量导致的急性肝损伤或衰竭患者数量没有变化，但非对乙酰氨基酚导致的急性肝损伤或衰竭入院人数有所减少。随着时间推移，对乙酰氨基酚组就诊时的疾病严重程度没有变化；非对乙酰氨基酚病因的患者后来出现的肝性脑病较轻。对乙酰氨基酚和非对乙酰氨基酚病因导致的急性肝衰竭患者的自发存活率随时间显著提高。在符合国王学院医院不良预后标准的最病重患者中，生存率改善最为明显。
由于非对乙酰氨基酚病例数量减少，SLTU急性肝衰竭入院人数正在下降。由于重症监护管理和肝移植应用的改善，这种病症的预后正在改善，在符合国王学院医院不良预后标准的患者中生存率提高最为明显。
