Valantine Bershic, Sundaray Nabakishore, Mishra Debakanta, Sahu Samir, Narayan Jimmy, Panda Baikuntha N, Singh Ayaskanta
Department of General Medicine IMS and SUM Hospital, Siksha 'O' Anusandhan, Deemed to be University Bhubaneswar India.
Department of Gastroenterology IMS and SUM Hospital, Siksha 'O' Anusandhan, Deemed to be University Bhubaneswar India.
JGH Open. 2021 May 19;5(6):686-694. doi: 10.1002/jgh3.12557. eCollection 2021 Jun.
Acute-on-chronic liver failure (ACLF) is a transpiring entity, which possesses high short-term/early mortality (28 days). Several mortality predictors have been studied, but none were proved reliable. Serum ferritin, an acute phase reactant and marker of hepatic necro-inflammation, is found to predict mortality in multiple liver diseases. We aimed to evaluate the role of serum ferritin and other clinical features, biochemical parameters and conventional scoring systems in predicting early mortality among ACLF.
A prospective cohort study was done from October 2017 to March 2019 at a tertiary care (non-transplant) center in eastern India. A total of consecutive 50 ACLF patients diagnosed, based on Asia Pacific Association for the Study of liver disease definition, were investigated for ferritin and other laboratory parameters on day-0, day-7, and followed up for 28 days.
Although the majority did not have organ failure (ACLF grade 0) according to European Association for Study of Liver-chronic liver failure sequential organ failure assessment criteria, early mortality was high (56%). On undergoing univariate analysis, multiple variables (ascites, HE, creatinine, total leucocyte count (TLC), bilirubin, albumin) predicted mortality. However, on multivariate analysis, only total bilirubin independently predicted. None of the scores on day-0 were predictive, while model for end-stage liver disease [area under the receiver operating characteristics (AUROC)-0.703, 95% confidence interval [CI]: 0.535-0.859] and Child-Turcotte-Pugh (AUROC-0.697, 95% CI: 0.550-0.855) on day-7 did.
ACLF is a dynamic process; day-7 assessment with above predictors, to be considered a milestone for prognostication and opting treatment modalities. Serum ferritin does not predict early mortality in ACLF.
慢加急性肝衰竭（ACLF）是一种正在形成的疾病实体，具有较高的短期/早期死亡率（28天）。已经对多种死亡率预测指标进行了研究，但均未被证明可靠。血清铁蛋白作为一种急性期反应物和肝脏坏死性炎症的标志物，已被发现可预测多种肝脏疾病的死亡率。我们旨在评估血清铁蛋白以及其他临床特征、生化参数和传统评分系统在预测ACLF患者早期死亡率中的作用。
2017年10月至2019年3月在印度东部的一家三级医疗（非移植）中心进行了一项前瞻性队列研究。根据亚太肝病研究协会的定义，共连续纳入50例确诊的ACLF患者，在第0天、第7天检测铁蛋白及其他实验室参数，并随访28天。
尽管根据欧洲肝脏研究协会-慢性肝衰竭序贯器官衰竭评估标准，大多数患者没有器官衰竭（ACLF 0级），但早期死亡率仍很高（56%）。单因素分析显示，多个变量（腹水、肝性脑病、肌酐、白细胞总数、胆红素、白蛋白）可预测死亡率。然而，多因素分析显示，只有总胆红素可独立预测死亡率。第0天的所有评分均无预测价值，而第7天的终末期肝病模型[受试者工作特征曲线下面积（AUROC）-0.703，95%置信区间（CI）：0.535-0.859]和Child-Turcotte-Pugh评分（AUROC-0.697，95%CI：0.550-0.855）有预测价值。
ACLF是一个动态过程；第7天用上述预测指标进行评估，可作为预后判断和选择治疗方式的一个里程碑。血清铁蛋白不能预测ACLF患者的早期死亡率。
