Department of Internal Medicine 1, University Hospital Frankfurt, Frankfurt am Main, Germany.
University Center for Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany.
Liver Int. 2018 Apr;38(4):645-653. doi: 10.1111/liv.13568. Epub 2017 Sep 15.
BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is characterized by an acute deterioration of liver function in patients with cirrhosis in combination with recently defined organ failures. Our aim was to independently validate the prognostic value of the recently established EASL-CLIF-Consortium definition of ACLF and to identify new predictors of short-term mortality.
Patients with cirrhosis and the International Classification of Diseases, Tenth Revision diagnosis of (sub)acute liver failure were retrospectively categorized according to the EASL-CLIF-Consortium definition. Logistic regression analyses were performed to identify clinical and epidemiological predictors of 30- and 90-day mortality.
From 2008 to 2015, 257 patients were included. Overall, 173 (67%) patients met the EASL criteria for ACLF (grade 1: n = 43 [25%], grade 2: n = 52 [30%], grade 3: n = 79 [45%]). Mortality within 30 days in patients without ACLF was 3.6%, and 18.6%, 37.3% and 62.0% in patients with ACLF grades 1, 2 and 3 respectively. Outcome of patients with bacterial infection-triggered ACLF was distinct from non-infection-triggered ACLF (71.6% vs 33.8% 30-day survival, P < .001), and infection-triggered ACLF was independently associated with increased mortality (odds ratio [OR] = 4.28, P < .001). Pneumonia was a particularly frequent infection and burdened with high mortality. In addition, infections with multidrug-resistant organisms were frequent and independently associated with mortality (P = .030, OR = 4.41), as was glycopeptide antibiotic therapy as initial empirical antibiotic therapy (P = .005).
This study confirmed the EASL-CLIF-Consortium definition of ACLF as strong predictor of mortality in patients with acute decompensation of cirrhosis. However, we have observed a remarkably higher mortality in infection-triggered ACLF compared to other precipitating events.
慢加急性肝衰竭（ACLF）的特征是肝硬化患者的肝功能急性恶化，同时伴有近期定义的器官衰竭。我们的目的是独立验证最近建立的 EASL-CLIF 联盟 ACLF 定义的预后价值，并确定短期死亡率的新预测因素。
回顾性地根据 EASL-CLIF 联盟的定义，将肝硬化和国际疾病分类，第十版诊断为（亚）急性肝功能衰竭的患者分为 ACLF 组。进行逻辑回归分析以确定 30 天和 90 天死亡率的临床和流行病学预测因素。
2008 年至 2015 年期间，共纳入 257 名患者。总体而言，173 名（67%）患者符合 EASL ACLF 标准（1 级：n=43[25%]，2 级：n=52[30%]，3 级：n=79[45%]）。无 ACLF 的患者 30 天内死亡率为 3.6%，而 ACLF 1 级、2 级和 3 级患者的死亡率分别为 18.6%、37.3%和 62.0%。细菌感染诱发的 ACLF 的患者预后明显不同于非感染诱发的 ACLF（30 天生存率为 71.6%比 33.8%，P<.001），感染诱发的 ACLF 与死亡率增加独立相关（优势比[OR] = 4.28，P<.001）。肺炎是一种特别常见的感染，死亡率很高。此外，多药耐药菌感染频繁且与死亡率独立相关（P=0.030，OR=4.41），初始经验性抗生素治疗使用糖肽类抗生素也是如此（P=0.005）。
本研究证实了 EASL-CLIF 联盟 ACLF 定义是肝硬化急性失代偿患者死亡率的有力预测因素。然而，我们观察到感染诱发的 ACLF 死亡率明显高于其他诱发事件。
