Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, United States.
Institute of Digestive Health & Liver Diseases, Mercy Medical Center, Baltimore, MD, United States; Department of Medicine, University of Maryland School of Medicine, Baltimore MD, United States.
J Hepatol. 2021 Nov;75(5):1096-1103. doi: 10.1016/j.jhep.2021.05.033. Epub 2021 Jun 5.
BACKGROUND & AIMS: There is no consensus on the best definition for acute-on-chronic liver failure (ACLF). In this study, we compared the prevalence and 30-day all-cause and transplant-free mortality of patients with ACLF identified by European Association for the Study of the Liver-Chronic Liver Failure Consortium (EASL-CLIF) and North American Consortium for the Study of End-stage Liver Disease (NACSELD) criteria.
We performed this comparative analysis using the United Network for Organ Sharing (UNOS) data from January 11, 2016 to August 31, 2020.
A total of 10,198 (21%) adult patients had EASL-CLIF ACLF grade 1-3, but of these only 15.3% had ACLF by NACSELD. Of the 2,562 with EASL-CLIF ACLF grade 3, only 48.8% had NACSELD-ACLF, 16.8% had no organ failure (OF) and 34.4% had 1 OF. The 30-day all-cause mortality was 1.5%, 7.7%, 13.3% and 25.8% for EASL-CLIF grade 0-3, respectively, and it was 15.4% and 28.1% in those without and with NACSELD-ACLF. When EASL-CLIF grade 3 patients were stratified by NACSELD OF, the mortality ranged from 18.6% with no OF to 41.0% with 4 OFs. The 30-day transplant-free mortality in those with no OF by NACSELD was 2.7%, but when the same group is stratified by EASL-CLIF grades 0-3, the mortality rates were 1.5%, 10.5%, 43.5% and 86%, respectively; the mortality rates ranged from 3.0% to 75.7% in those with 1 OF by NACSELD.
There is a clear discordance in the prevalence and 30-day mortality rates of patients with ACLF identified by the EASL-CLIF and NACSELD criteria. EASL-CLIF criteria have a better sensitivity to detect ACLF and have a better prognostic capability.
There is no consensus on the definition of acute-on-chronic liver failure. European (EASL-CLIF) and North American (NACSELD) consortia have each proposed a commonly used definition. In this study, we compared the prevalence and short-term (30-day) mortality based on these definitions. Using a very large data set, we observed that there was a significant discordance in the prevalence and mortality based on these criteria. EASL-CLIF criteria appeared to be more sensitive to identify acute-on-chronic liver failure, and were better at predicting all-cause and short-term mortality.
目前对于慢加急性肝衰竭（ACLF）尚无统一的定义。本研究旨在比较欧洲肝脏研究协会-慢性肝脏衰竭联盟（EASL-CLIF）和北美终末期肝脏疾病研究联盟（NACSELD）标准定义的 ACLF 患者的患病率及 30 天全因死亡率和无移植死亡率。
我们对 2016 年 1 月 11 日至 2020 年 8 月 31 日期间美国器官共享联合网络（UNOS）的数据进行了这项对比分析。
共有 10198 例（21%）成年患者符合 EASL-CLIF ACLF 1-3 级，但其中仅 15.3%符合 NACSELD 标准。在 2562 例 EASL-CLIF ACLF 3 级患者中，仅有 48.8%符合 NACSELD-ACLF，16.8%无器官衰竭（OF），34.4%仅有 1 个 OF。EASL-CLIF 0-3 级患者的 30 天全因死亡率分别为 1.5%、7.7%、13.3%和 25.8%，而无 NACSELD-ACLF 和有 NACSELD-ACLF 的患者死亡率分别为 15.4%和 28.1%。当根据 NACSELD OF 将 EASL-CLIF 3 级患者分层时，死亡率范围从无 OF 的 18.6%到有 4 个 OF 的 41.0%。无 NACSELD OF 的患者 30 天无移植死亡率为 2.7%，但将同一组根据 EASL-CLIF 0-3 级分层时，死亡率分别为 1.5%、10.5%、43.5%和 86%；在有 1 个 OF 的 NACSELD 患者中，死亡率范围为 3.0%至 75.7%。
EASL-CLIF 和 NACSELD 标准定义的 ACLF 患者的患病率和 30 天死亡率存在明显差异。EASL-CLIF 标准对 ACLF 的检测更敏感，具有更好的预后能力。
目前对于慢加急性肝衰竭尚无统一定义。欧洲（EASL-CLIF）和北美（NACSELD）联盟各自提出了常用的定义。本研究比较了基于这些定义的患病率和短期（30 天）死亡率。我们使用一个非常大的数据集，观察到基于这些标准的患病率和死亡率存在显著差异。EASL-CLIF 标准似乎更能敏感地识别慢加急性肝衰竭，并且更能预测全因死亡率和短期死亡率。
