预测 ICU 收治的慢加急性肝衰竭患者 28 天病死率的因素。

Predictive factors for 28-day mortality in acute-on-chronic liver failure patients admitted to the intensive care unit.

机构信息

University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.

University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom; Centre for Liver and Gastrointestinal Research, Institute for Immunology and Immunotherapy,University of Birmingham, Birmingham, United Kingdom; National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, University Hospitals Birmingham NHS Foundation Trust and University of Birmingham, Birmingham, United Kingdom.

出版信息

Dig Liver Dis. 2019 Oct;51(10):1416-1422. doi: 10.1016/j.dld.2019.04.008. Epub 2019 May 4.

DOI:10.1016/j.dld.2019.04.008

PMID:31064706

Abstract

BACKGROUND

Acute-on-chronic liver failure (ACLF) is an entity comprising an acute deterioration of liver function in cirrhotic patients, associated with organ failure(s) and high short-term mortality. We aimed to identify predictive factors for short-term mortality in patients admitted with ACLF that may benefit most from liver transplantation.

METHODS

Retrospective analysis of patients admitted in ACLF to a tertiary intensive care unit between 2013 and 2017 was performed. The EASL-CLIF acute-on-chronic liver failure in cirrhosis (CANONIC) criteria were used to define ACLF grade. Multivariable analysis using 28-day mortality as an end-point was performed, including severity-of-disease scores and clinical parameters.

RESULTS

Seventy-seven patients were admitted in ACLF over the study period. The commonest aetiology of liver disease was alcohol related 52/77(68%) and the commonest precipitant of ACLF was variceal haemorrhage 38/77(49%). Overall 28-day mortality was 42/77(55%) [ACLF-(grade)1:3/42(7%); ACLF-2:10/42(24%); and, ACLF-3:29/42(69%);p = 0.002]. On multivariable analysis MELD ≥ 26 [odds ratio(OR) = 11.559; 95% confidence interval(CI):2.820-47.382;p = 0.001], ACLF-3 (OR = 3.287; 95%CI:1.047-10.325;p = 0.042) at admission and requirement for renal replacement therapy (OR = 5.348; 95%CI:1.385-20.645;p = 0.015) were independently associated with 28-day mortality.

CONCLUSION

Patients admitted with ACLF to intensive care have a high mortality rate. Defined early thresholds at admission can identify patients at the highest risk that may benefit most from liver transplantation.

摘要

背景

慢加急性肝衰竭（ACLF）是一种在肝硬化患者中发生的肝功能急性恶化的病症，伴有器官衰竭和高短期死亡率。我们旨在确定可能从肝移植中获益最多的因 ACLF 入院的患者的短期死亡率的预测因素。

方法

对 2013 年至 2017 年期间在三级重症监护病房因 ACLF 入院的患者进行回顾性分析。使用 EASL-CLIF 肝硬化急性肝衰竭（CANONIC）标准定义 ACLF 分级。使用 28 天死亡率作为终点进行多变量分析，包括疾病严重程度评分和临床参数。

结果

在研究期间，共有 77 例患者因 ACLF 入院。最常见的肝病病因是酒精相关性，52/77（68%），最常见的 ACLF 诱发因素是静脉曲张出血，38/77（49%）。总体 28 天死亡率为 42/77（55%）[ACLF-（分级）1：3/42（7%）；ACLF-2：10/42（24%）；和 ACLF-3：29/42（69%）；p=0.002]。多变量分析显示，MELD≥26[比值比（OR）=11.559；95%置信区间（CI）：2.820-47.382；p=0.001]、入院时的 ACLF-3（OR=3.287；95%CI：1.047-10.325；p=0.042）和需要肾脏替代治疗（OR=5.348；95%CI：1.385-20.645；p=0.015）与 28 天死亡率独立相关。