Gastroenterology and Hepatology Unit, Bonsucesso Federal Hospital, (Ministry of Health), Rio de Janeiro, Brazil; Estácio de Sá University, School of Medicine, Rio de Janeiro, Brazil.
Gastroenterology and Hepatology Unit, Bonsucesso Federal Hospital, (Ministry of Health), Rio de Janeiro, Brazil.
Dig Liver Dis. 2020 Jan;52(1):91-97. doi: 10.1016/j.dld.2019.08.013. Epub 2019 Sep 19.
Few studies have evaluated whether combination and sequential evaluation of ACLF (acute-on-chronic liver failure) and hyponatremia aids prognosis.
Describe clinical course and determine prognostic capability of assessing ACLF and hyponatremia at specific time-points.
Prospective study with inclusion of 376 patients. ACLF and hyponatremia were evaluated at days 1 and 7 and classified as persistent, transient, de novo or absent. Follow-up was 90 days.
At inclusion, ACLF was diagnosed in 99 patients. Reversal was observed in 57 patients and was associated with lower creatinine and ACLF grade. De novo ACLF developed in 19 patients, and MELD (model of end-stage liver disease) score and lower albumin were predictive factors. Hyponatremia was present in 76 patients (persistent, transient and de novo in 27, 24 and 25 respectively). ACLF at D7 had the lowest survival compared to transient or no ACLF (21, 57 and 80%, p < 0.0001). Hyponatremia at admission was associated with low survival (35%) whereas survival was higher for de novo or absent cases (70%), p < 0.001. In multivariate analysis ACLF at D7 and hyponatremia at D1 were predictors of survival.
ACLF and hyponatremia are dynamic and evaluation of both conditions at different time-points identifies patients at higher risk of short-term mortality.
很少有研究评估 ACLF（急性肝衰竭）和低钠血症的联合和序贯评估是否有助于预后。
描述临床过程，并确定在特定时间点评估 ACLF 和低钠血症的预后能力。
前瞻性研究，纳入 376 例患者。在第 1 天和第 7 天评估 ACLF 和低钠血症，并分类为持续、短暂、新发或无。随访 90 天。
纳入时，99 例患者诊断为 ACLF。57 例患者出现逆转，与肌酐降低和 ACLF 分级相关。19 例患者新发 ACLF，MELD（终末期肝病模型）评分和白蛋白降低是预测因素。76 例患者存在低钠血症（持续、短暂和新发分别为 27、24 和 25 例）。与短暂或无 ACLF 相比，第 7 天的 ACLF 存活率最低（21%、57%和 80%，p<0.0001）。入院时的低钠血症与低生存率（35%）相关，而新发或无低钠血症的生存率更高（70%），p<0.001。多变量分析显示，第 7 天的 ACLF 和第 1 天的低钠血症是生存率的预测因素。
ACLF 和低钠血症是动态的，在不同时间点评估两种情况可识别出短期死亡率更高的患者。
