Xu Man-Man, Kong Ming, Yu Peng-Fei, Cao Ying-Ying, Liu Fang, Zhu Bing, Zhang Yi-Zhi, Lu Wang, Zou Huai-Bin, Duan Bin-Wei, You Shao-Li, Xin Shao-Jie, Han Tao, Duan Zhong-Ping, Chen Yu
Fourth Department of Liver Disease (Difficult & Complicated Liver Diseases and Artificial Liver Center), Beijing You'an Hospital Affiliated to Capital Medical University, Beijing, China.
Beijing Municipal Key Laboratory of Liver Failure and Artificial Liver Treatment Research, Beijing, China.
J Clin Transl Hepatol. 2021 Oct 28;9(5):626-634. doi: 10.14218/JCTH.2020.00179. Epub 2021 Apr 16.
Acute-on-chronic liver failure (ACLF) is acute decompensation of liver function in the setting of chronic liver disease, and characterized by high short-term mortality. In this study, we sought to investigate the clinical course of patients at specific time points, and to propose dynamic prognostic criteria.
We assessed the clinical course of 453 patients with ACLF during a 12-week follow-up period in this retrospective multicenter study. The clinical course of patients was defined as disease recovery, improvement, worsening or steady patterns based on the variation tendency in prothrombin activity (PTA) and total bilirubin (TB) at different time points.
Resolution of PTA was observed in 231 patients (51%) at 12 weeks after the diagnosis of ACLF. Among the remaining patients, 66 (14.6%) showed improvement and 156 (34.4%) showed a steady or worsening course. In patients with resolved PTA, the clinical course of TB exhibited resolved pattern in 95.2%, improved in 3.9%, and steady or worse in 0.8%. Correspondingly, in patients with improved PTA, these values for TB were 28.8%, 27.3%, and 43.9%, respectively. In patients with steady or worsening PTA, these values for TB were 5.7%, 32.3%, and 65.6%, respectively. Dynamic prognostic criteria were developed by combining the clinical course of PTA/TB and the clinical outcomes at 4 and 12 weeks after diagnosis in ACLF patients.
We propose the following dynamic prognostic criteria: rapid progression, slow progression, rapid recovery, slow recovery, and slow persistence, which lay the foundation for precise prediction of prognosis and the improvement of ACLF therapy.
慢加急性肝衰竭（ACLF）是慢性肝病背景下肝功能的急性失代偿，其特征是短期死亡率高。在本研究中，我们试图在特定时间点调查患者的临床病程，并提出动态预后标准。
在这项回顾性多中心研究中，我们评估了453例ACLF患者在12周随访期内的临床病程。根据不同时间点凝血酶原活动度（PTA）和总胆红素（TB）的变化趋势，将患者的临床病程定义为疾病恢复、改善、恶化或稳定模式。
在ACLF诊断后12周，231例患者（51%）的PTA恢复正常。在其余患者中，66例（14.6%）病情改善，156例（34.4%）病情稳定或恶化。在PTA恢复正常的患者中，TB的临床病程表现为恢复模式的占95.2%，改善的占3.9%，稳定或恶化的占0.8%。相应地，在PTA改善的患者中，TB的这些值分别为28.8%、27.3%和43.9%。在PTA稳定或恶化的患者中，TB的这些值分别为5.7%、32.3%和65.6%。通过结合ACLF患者诊断后4周和12周的PTA/TB临床病程及临床结局，制定了动态预后标准。
我们提出以下动态预后标准：快速进展、缓慢进展、快速恢复、缓慢恢复和缓慢持续，这为精确预测预后及改善ACLF治疗奠定了基础。
