Tropical Medicine and Gastroenterology Department, Al-Rajhi Liver Hospital, Assiut University Hospitals, Assiut, Egypt.
Hospital Israelita Albert Einstein, São Paulo, Brazil.
Eur J Gastroenterol Hepatol. 2021 Dec 1;33(1S Suppl 1):e458-e463. doi: 10.1097/MEG.0000000000002132.
Acute-on-chronic liver failure (ACLF) is a severe liver cirrhosis complication with high mortality rates. Despite that chronic liver diseases are prevalent in Egypt, there is no available data about patients with ACLF. We aimed to evaluate the pattern of ACLF in Egypt.
This prospective cohort study included all patients with ACLF, according to the American Association for the Study of Liver Diseases and the European Association for the Study of the Liver, admitted to Al-Rajhi liver Hospital, Egypt, between November 2018 and October 2019. We recorded data at admission, days 3, 7, 14 and 28, and calculated ACLF grades and Chronic Liver Failure Consortium scores until discharge or death. Kaplan-Meier survival analysis was used for survival analysis.
We analyzed 52 patients with ACLF. Liver cirrhosis was secondary to hepatitis C virus in 46 patients (88.9%), and hepatitis B virus in 4 (7.4%). The main ACLF precipitating factors were infection in 38 (73.1%) and variceal bleeding in 9 (17.3%). The most common infections were spontaneous bacterial peritonitis (44.7%) and chest infection (31.6%). The 28 and 90-day mortality rates were 86.5 and 96.2%. None of the patients who survived >28 days had ACLF 3 at admission or day 7. Among those who died <28 days, ACLF 3 was reported in 7 at admission and 19 on day 7. Living donor liver transplantation was not offered in any case.
In this study, the 28-day mortality rate was higher than in the literature. Egypt urgently needs to develop specific protocols for the proper management of ACLF.
急性肝衰竭（ACLF）是一种严重的肝硬化并发症，死亡率很高。尽管埃及慢性肝病较为普遍，但目前尚无 ACLF 患者的相关数据。我们旨在评估埃及 ACLF 的发病模式。
本前瞻性队列研究纳入了 2018 年 11 月至 2019 年 10 月期间在埃及 Al-Rajhi 肝脏医院因 ACLF 住院的所有患者。我们记录了入院时、第 3、7、14 和 28 天的数据，并计算了 ACLF 分级和慢性肝脏衰竭联盟评分，直至出院或死亡。采用 Kaplan-Meier 生存分析进行生存分析。
我们分析了 52 例 ACLF 患者。46 例（88.9%）患者的肝硬化继发于丙型肝炎病毒，4 例（7.4%）继发于乙型肝炎病毒。ACLF 的主要诱发因素是 38 例（73.1%）感染和 9 例（17.3%）静脉曲张出血。最常见的感染是自发性细菌性腹膜炎（44.7%）和胸部感染（31.6%）。28 天和 90 天的死亡率分别为 86.5%和 96.2%。在存活超过 28 天的患者中，没有任何患者在入院时或第 7 天患有 ACLF3。在 28 天内死亡的患者中，7 例患者在入院时患有 ACLF3，19 例患者在第 7 天患有 ACLF3。没有为任何患者提供活体供肝移植。
在本研究中，28 天死亡率高于文献报道。埃及急需制定 ACLF 正确管理的具体方案。
