Section of Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX Center, Houston, TX, USA; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
Section of Gastroenterology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX Center, Houston, TX, USA; Center for Innovations in Quality, Effectiveness and Safety (IQuESt), Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA; Section of Gastroenterology and Hepatology, Department of Medicine, Baylor College of Medicine, Houston, TX, USA.
J Hepatol. 2019 Apr;70(4):639-647. doi: 10.1016/j.jhep.2018.12.018. Epub 2018 Dec 25.
BACKGROUND & AIMS: Acute-on-chronic liver failure (ACLF) is characterised by the presence of organ failure in patients with decompensated cirrhosis and is associated with high short-term mortality. However, there are limited data on the prevalence and short-term outcomes of ACLF in patients with cirrhosis seen in the US. We aimed to study the prevalence and risk factors associated with the development and short term mortality in a large cohort of patients in the US.
Using the US Department of Veterans Affairs (VA) Corporate Data Warehouse, we identified patients with ACLF during hospitalisation for decompensated cirrhosis at any of the 127 VA hospitals between January 1, 2004, and December 31, 2014. We examined the prevalence of ACLF and variables associated with 28- and 90-day mortality in ACLF, and trends in prevalence and survival over time.
Of 72,316 patients hospitalised for decompensated cirrhosis, 19,082 (26.4%) patients met the criteria of ACLF on admission. Of these, 12.8% had 1, 10.1% had 2, and 3.5% had 3 or more organ failures. Overall, 25.5% and 40.0% of ACLF patients died within 28 days and 90 days of admission, respectively. Older age, White race, liver cancer, higher model for end-stage liver disease sodium corrected score, and non-liver transplant centre were associated with increased risk of death in ACLF. Over the study period, the prevalence of ACLF decreased, and all grades but ACLF-3 had improvement in survival.
In a US cohort of hospitalised patients with decompensated cirrhosis, ACLF was common and associated with high short-term mortality. Over a decade, ACLF prevalence decreased but survival improvement of ACLF-3 was not seen. Early recognition and aggressive management including timely referral to transplant centres may lead to improved outcomes in ACLF.
Acute-on-chronic liver failure (ACLF) is a condition marked by multiple organ failures in patients with cirrhosis and associated with a high risk of death. In this study of US patients hospitalised with cirrhosis, 1 in 4 patients developed ACLF. In total, 25% of patients with ACLF died within 1 month and 40% died within 3 months. Thus, early recognition of ACLF is important for the initiation of aggressive management, which is required to save these patients' lives.
急性肝衰竭合并慢性肝病（ACLF）的特点是失代偿性肝硬化患者存在器官衰竭，与短期死亡率高相关。然而，美国肝硬化患者 ACLF 的患病率和短期预后数据有限。本研究旨在研究美国一个大型队列患者的 ACLF 患病率及其与发生和短期死亡率相关的危险因素。
我们使用美国退伍军人事务部（VA）公司数据库，确定 2004 年 1 月 1 日至 2014 年 12 月 31 日期间在 127 家 VA 医院中任何一家医院因失代偿性肝硬化住院的 ACLF 患者。我们检查了 ACLF 的患病率以及与 ACLF 患者 28 天和 90 天死亡率相关的变量，以及随时间推移的患病率和生存趋势。
在因失代偿性肝硬化住院的 72316 名患者中，有 19082 名（26.4%）患者入院时符合 ACLF 标准。其中，12.8%的患者有 1 个器官衰竭，10.1%的患者有 2 个器官衰竭，3.5%的患者有 3 个或更多器官衰竭。总体而言，25.5%和 40.0%的 ACLF 患者分别在入院后 28 天和 90 天内死亡。年龄较大、白人、肝癌、较高的终末期肝病模型钠校正评分和非肝移植中心与 ACLF 患者死亡风险增加相关。在研究期间，ACLF 的患病率下降，除 ACLF-3 外，所有等级的 ACLF 患者的生存率均有所提高。
在美国因失代偿性肝硬化住院的患者队列中，ACLF 很常见，且与短期死亡率高相关。在过去的十年中，ACLF 的患病率有所下降，但 ACLF-3 的生存率并未改善。早期识别和积极管理，包括及时转至移植中心，可能会改善 ACLF 的预后。
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