Dong Victor, Karvellas Constantine J
Division of Gastroenterology, University of Alberta, Edmonton, Canada.
Department of Critical Care Medicine, University of Alberta, Edmonton, Canada.
JHEP Rep. 2019 Mar 18;1(1):44-52. doi: 10.1016/j.jhepr.2019.02.005. eCollection 2019 May.
Cirrhosis is a leading cause of morbidity and mortality throughout the world. Significant complications include variceal bleeding, hepatic encephalopathy, hepatorenal syndrome, and infection. When these complications are severe, admission to the intensive care unit (ICU) is often required for organ support and management. Intensive care therapy can also serve as a bridge to liver transplantation. Along with decompensation of cirrhosis, the concept of acute-on-chronic liver failure (ACLF) has emerged. This involves an acute precipitating event, such as the development of infection in a patient with cirrhosis, which leads to acute deterioration of hepatic function and extrahepatic organ failure. Extrahepatic complications often include renal, cardiovascular, and respiratory failures. Patients with significant extrahepatic and hepatic failures need ICU admission for organ support. Again, in patients who are deemed suitable liver transplant candidates, intensive care management may allow bridging to liver transplantation. However, patients with a Chronic Liver Failure Consortium ACLF score greater than 70 at 48 to 72 hours post-ICU admission do not seem to benefit from ongoing intensive support and a palliative approach may be more appropriate.
肝硬化是全球发病和死亡的主要原因。严重并发症包括静脉曲张出血、肝性脑病、肝肾综合征和感染。当这些并发症严重时，往往需要入住重症监护病房（ICU）进行器官支持和管理。重症监护治疗也可作为肝移植的桥梁。随着肝硬化失代偿，急性慢性肝衰竭（ACLF）的概念应运而生。这涉及急性促发事件，如肝硬化患者发生感染，导致肝功能急性恶化和肝外器官衰竭。肝外并发症通常包括肾、心血管和呼吸衰竭。有严重肝外和肝功能衰竭的患者需要入住ICU进行器官支持。同样，对于被认为适合肝移植的患者，重症监护管理可能有助于过渡到肝移植。然而，在ICU入院后48至72小时慢性肝衰竭协会ACLF评分大于70的患者似乎无法从持续的重症支持中获益，采取姑息治疗方法可能更为合适。
