Rodrigues-Filho Edison Moraes, Fernandes Rogério, Garcez Anderson
Unidade de Terapia Intensiva de Transplantes, Hospital Dom Vicente Scherer, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
Grupo de Transplante Hepático, Hospital Dom Vicente Scherer, Irmandade Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, RS, Brazil.
Rev Bras Ter Intensiva. 2018 Mar;30(1):64-70. doi: 10.5935/0103-507x.20180012.
To describe a cohort of patients with acute liver failure and to analyze the demographic and clinical factors associated with mortality.
Retrospective cohort study in which all patients admitted for acute liver failure from July 28, 2012, to August 31, 2017, were included. Clinical and demographic data were collected using the Epimed System. The SAPS 3, SOFA, and MELD scores were measured. The odds ratios and 95% confidence intervals were estimated. Receiver operating characteristics curves were obtained for the prognostic scores, along with the Kaplan-Meier survival curve for the score best predicting mortality.
The majority of the 40 patients were female (77.5%), and the most frequent etiology was hepatitis B (n = 13). Only 35% of the patients underwent liver transplantation. The in-hospital mortality rate was 57.5% (95%CI: 41.5 - 73.5). Among the scores investigated, only SOFA remained associated with risk of death (OR = 1.37; 95%CI 1.11 - 1.69; p < 0.001). After SOFA stratification into < 12 and ≥ 12 points, survival was higher in patients with SOFA <12 (log-rank p < 0.001).
SOFA score in the first 24 hours was the best predictor of fatal outcome.
描述一组急性肝衰竭患者，并分析与死亡率相关的人口统计学和临床因素。
进行回顾性队列研究，纳入2012年7月28日至2017年8月31日期间因急性肝衰竭入院的所有患者。使用淫羊藿系统收集临床和人口统计学数据。测量SAPS 3、SOFA和MELD评分。估计比值比和95%置信区间。获得预后评分的受试者工作特征曲线，以及对死亡率预测最佳的评分的Kaplan-Meier生存曲线。
40例患者中大多数为女性（77.5%），最常见的病因是乙型肝炎（n = 13）。只有35%的患者接受了肝移植。住院死亡率为57.5%（95%CI：41.5 - 73.5）。在所研究的评分中，只有SOFA仍然与死亡风险相关（OR = 1.37；95%CI 1.11 - 1.69；p < 0.001）。将SOFA分层为< 12分和≥ 12分后，SOFA <12分的患者生存率更高（对数秩检验p < 0.001）。
最初24小时的SOFA评分是致命结局的最佳预测指标。
