State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, Collaborative Innovation Center for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, China.
Infectious disease department, Shulan (Hangzhou) Hospital, Hangzhou, China.
Can J Gastroenterol Hepatol. 2018 Jan 28;2018:5108781. doi: 10.1155/2018/5108781. eCollection 2018.
To date, few studies are available on autoimmune liver disease-associated acute-on-chronic liver failure (ACLF). The aim of this study is to investigate bacterial infection and predictors of mortality in these patients.
We retrospectively studied patients with autoimmune liver disease from August 2012 to August 2017. Clinical data of the patients were retrieved for analysis.
There were 53 ACLF patients and 53 patients without ACLF in this study. The ACLF group had a higher prevalence of complications ( < 0.05). The 28-day and 90-day mortality rates were also obviously high in patients with ACLF (38.3% and 74.5%, resp.) ( < 0.05). No predictor was significantly associated with 28-day and 90-day transplant-free mortality. In 53ACLF patients, 40 (75.5%) patients showed bacterial infection. ACLF patients with bacterial infection showed high Child-Pugh score, MELD score, CLIF-SOFA score, 28-day mortality, and 90-day mortality ( > 0.05). Moreover, C-reactive protein (CRP) using 12.15 mg/L cut-off value proved to be more accurate than procalcitonin in identifying patients with infection.
Autoimmune liver disease-associated ACLF showed more complications and high mortality. Bacterial infection patients displayed a more severe condition than those without infection. Elevated CRP is an accurate marker for diagnosing bacterial infection in autoimmune liver disease-associated ACLF patients.
迄今为止，关于自身免疫性肝病相关慢加急性肝衰竭（ACLF）的研究较少。本研究旨在探讨此类患者的细菌感染情况及死亡预测因素。
我们回顾性研究了 2012 年 8 月至 2017 年 8 月期间的自身免疫性肝病患者。对患者的临床资料进行了检索分析。
本研究共纳入 53 例 ACLF 患者和 53 例非 ACLF 患者。ACLF 组并发症发生率较高（<0.05）。ACLF 患者的 28 天和 90 天死亡率也明显较高（分别为 38.3%和 74.5%）（<0.05）。无预测因素与 28 天和 90 天无移植死亡率显著相关。在 53 例 ACLF 患者中，40 例（75.5%）患者存在细菌感染。合并细菌感染的 ACLF 患者的 Child-Pugh 评分、MELD 评分、CLIF-SOFA 评分、28 天死亡率和 90 天死亡率均较高（>0.05）。此外，使用 12.15mg/L 截断值的 C 反应蛋白（CRP）比降钙素原更能准确识别感染患者。
自身免疫性肝病相关 ACLF 并发症更多，死亡率更高。细菌感染患者的病情比未感染患者更严重。升高的 CRP 是诊断自身免疫性肝病相关 ACLF 患者细菌感染的准确标志物。
