Department of Laboratory Medicine, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Rd, Hangzhou City, 310003, China.
State Key Laboratory for Diagnosis and Treatment of Infectious Diseases, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Rd, Hangzhou City, 310003, China.
Sci Rep. 2020 May 22;10(1):8577. doi: 10.1038/s41598-020-65529-5.
The aim of the study was to identify the characteristics and outcomes in acute-on-chronic liver failure (ACLF) patients with or without cirrhosis using two criteria. Patients with acute deterioration of chronic hepatic disease or acute decompensation of cirrhosis were included retrospectively from April 10, 2016 to April 10, 2019. European Association for the Study of the Liver-chronic liver failure (EASL-CLIF) criterion except for consideration of cirrhosis and Chinese Group on the Study of Severe Hepatitis B (COSSH) criterion were used. Clinical features, laboratory data and survival curves were compared between the ACLF patients with and without cirrhosis. A total of 799 patients were included. Among them, 328 had COSSH and EASL ACLF, 197 had COSSH alone, and 104 had EASL alone. There were 11.6% more ACLF with COSSH criterion. Furthermore, EASL ACLF patients with non-cirrhosis vs. cirrhosis had different laboratory characteristics: ALT (423 vs. 154, p < 0.001), AST (303 vs. 157, p < 0.001), γ-GT (86 vs. 75, p < 0.01), and INR (2.7 vs. 2.6, p < 0.001) were significantly higher but creatinine (71 vs. 77, p < 0.01) were significantly lower; but importantly there was no statistical changes between non-cirrhosis and cirrhosis in EASL ACLF patients on 28-day (p = 0.398) and 90-day (p = 0.376) survival curves. However, 90-day (p = 0.030) survival curve was different between non-cirrhosis and cirrhosis in COSSH ACLF patients. COSSH ACLF score (auROC = 0.778 or 0.792, 95%CI 0.706-0.839 or 0.721-0.851) displayed the better prognostic ability for EASL ACLF patients with non-cirrhosis, but CLIF-C ACLF score (auROC = 0.757 or 0.796, 95%CI 0.701-0.807 or 0.743-0.843) still was the best prognostic scoring system in EASL ACLF patients with cirrhosis. In conclusions, EASL definition exhibited better performance on homogeneous identification of ACLF regardless of cirrhosis or non-cirrhosis. And COSSH ACLF score displayed the better prognostic ability for EASL ACLF patients without cirrhosis.
研究目的是使用两种标准来确定急性慢性肝衰竭（ACLF）患者伴或不伴肝硬化的特征和结局。2016 年 4 月 10 日至 2019 年 4 月 10 日，回顾性纳入了慢性肝病急性恶化或肝硬化急性失代偿的患者。使用了欧洲肝脏研究协会-慢性肝衰竭（EASL-CLIF）标准，但不考虑肝硬化和中国重型乙型肝炎研究组（COSSH）标准。比较了伴或不伴肝硬化的 ACLF 患者的临床特征、实验室数据和生存曲线。共纳入 799 例患者。其中，328 例符合 COSSH 和 EASL ACLF 标准，197 例仅符合 COSSH 标准，104 例仅符合 EASL 标准。符合 COSSH 标准的 ACLF 患者多 11.6%。此外，EASL ACLF 患者中非肝硬化与肝硬化的实验室特征不同：ALT（423 vs. 154，p < 0.001）、AST（303 vs. 157，p < 0.001）、γ-GT（86 vs. 75，p < 0.01）和 INR（2.7 vs. 2.6，p < 0.001）显著升高，但肌酐（71 vs. 77，p < 0.01）显著降低；但重要的是，EASL ACLF 患者非肝硬化和肝硬化的 28 天（p = 0.398）和 90 天（p = 0.376）生存率曲线之间没有统计学差异。然而，COSSH ACLF 患者的 90 天（p = 0.030）生存率曲线在非肝硬化和肝硬化之间存在差异。COSSH ACLF 评分（auROC = 0.778 或 0.792，95%CI 0.706-0.839 或 0.721-0.851）对非肝硬化 EASL ACLF 患者的预后能力较好，但 CLIF-C ACLF 评分（auROC = 0.757 或 0.796，95%CI 0.701-0.807 或 0.743-0.843）仍然是肝硬化 EASL ACLF 患者的最佳预后评分系统。总之，EASL 定义在不考虑肝硬化或非肝硬化的情况下，对 ACLF 的同质识别表现更好。COSSH ACLF 评分对非肝硬化 EASL ACLF 患者的预后能力较好。
