Lu Cheng-Yueh, Chen Chi-Ling, Ho Cheng-Maw, Hsiao Chih-Yang, Wu Yao-Ming, Ho Ming-Chih, Lee Po-Huang, Hu Rey-Heng
Department of Surgery, National Taiwan University Hospital and College of Medicine, Taipei 100, Taiwan.
Graduate Institute of Clinical Medicine, National Taiwan University, Taipei 100, Taiwan.
J Pers Med. 2020 Nov 15;10(4):230. doi: 10.3390/jpm10040230.
We aimed to extensively investigate clinical markers that are sufficiently dynamic for prognosis of acute-on-chronic liver failure (ACLF). Defined by the Asian Pacific Association for the Study of the Liver (APASL) criteria, patients with ACLF on the liver transplant waitlist in a tertiary center were retrospectively reviewed. Laboratory results and severity scores at three time points (days 1, 7, and 14 after admission) were analyzed. From 2015 to 2019, 64 patients with ACLF were enrolled, of which 24 received a liver transplant from 22 live donors. The hospital mortality rate was 31% (8% for transplant; 45% for nontransplant groups), and the 3-month survival was crucial for determining long-term outcomes. The number of significant variables for mortality, and, specifically, the hazards of international normalized ratio of prothrombin time (INR) and APASL ACLF Research Consortium (AARC) score were increased within two weeks. In multivariable analysis, INR and AARC score (D-14) were associated with poor survival and liver transplant was a protective factor in all patients, while AARC score (D-14) was significant in the nontransplant group. AARC score at day 14 is an independent risk factor for mortality in ACLF. Liver transplant from live donors reversed poor outcomes in patients with ACLF in a timely manner.
我们旨在广泛研究对于慢加急性肝衰竭（ACLF）预后具有足够动态变化的临床指标。根据亚太肝脏研究协会（APASL）标准定义，对一家三级中心肝移植等待名单上的ACLF患者进行回顾性研究。分析了三个时间点（入院后第1天、第7天和第14天）的实验室检查结果和严重程度评分。2015年至2019年，共纳入64例ACLF患者，其中24例接受了来自22位活体供者的肝移植。医院死亡率为31%（移植组为8%；非移植组为45%），3个月生存率对于确定长期预后至关重要。死亡的显著变量数量，尤其是凝血酶原时间国际标准化比值（INR）和APASL ACLF研究联盟（AARC）评分的风险在两周内增加。在多变量分析中，INR和AARC评分（第14天）与生存不良相关，肝移植对所有患者都是一个保护因素，而AARC评分（第14天）在非移植组中具有显著性。第14天的AARC评分是ACLF患者死亡的独立危险因素。活体供者肝移植及时逆转了ACLF患者的不良预后。
