Department of Critical Care, University Hospital Birmingham, Birmingham, UK.
University of Birmingham Medical School, University of Birmingham, Birmingham, UK.
Br J Hosp Med (Lond). 2020 Sep 2;81(9):1-6. doi: 10.12968/hmed.2020.0310. Epub 2020 Sep 7.
Acute-on-chronic liver failure is used to describe an acute decline in liver function in a patient with existing liver disease combined with other organ failure. Acute-on-chronic liver failure is associated with high short-term mortality, and the greater the number and severity of organ failures, the higher the mortality. The most commonly identified precipitants of acute-on-chronic liver failure include bacterial infection, gastrointestinal haemorrhage, viral hepatitis and recent excessive alcohol intake. Since some of these aetiologies are treatable, organ failure may return to pre-decompensation levels in up to 55% of patients. As a result, a trial of critical care treatment may be appropriate for many of these patients. Clinical scoring tools may help clinicians recognise futility, allowing timely withdrawal of organ support and shifting the focus of care toward palliation.
急性慢性肝衰竭用于描述患有现有肝脏疾病的患者的肝功能突然下降，同时伴有其他器官衰竭。急性慢性肝衰竭与高短期死亡率相关，器官衰竭的数量和严重程度越高，死亡率越高。急性慢性肝衰竭最常见的诱因包括细菌感染、胃肠道出血、病毒性肝炎和近期过量饮酒。由于其中一些病因是可治疗的，多达 55%的患者的器官衰竭可能会恢复到代偿前水平。因此，对许多这些患者进行重症监护治疗的尝试可能是合适的。临床评分工具可以帮助临床医生识别无效性，从而及时停止器官支持，并将护理重点转向缓解。
