da Silveira Fernando, Soares Pedro H R, Marchesan Luana Q, da Fonseca Roberto S A, Nedel Wagner L
Programa de Pós-Graduação em Pneumologia, Universidade Federal do Rio Grande do Sul, Porto Alegre 91430835, Brazil.
Intensive Care Unit, Grupo Hospitalar Conceição, Porto Alegre 91430835, Brazil.
World J Hepatol. 2021 Oct 27;13(10):1341-1350. doi: 10.4254/wjh.v13.i10.1341.
Critically ill cirrhotic patients have high in-hospital mortality and utilize significant health care resources as a consequence of the need for multiorgan support. Despite this fact, their mortality has decreased in recent decades due to improved care of critically ill patients. Acute-on-chronic liver failure (ACLF), sepsis and elevated hepatic scores are associated with increased mortality in this population, especially among those not eligible for liver transplantation. No score is superior to another in the prognostic assessment of these patients, and both liver-specific and intensive care unit-specific scores have satisfactory predictive accuracy. The sequential assessment of the scores, especially the Sequential Organ Failure Assessment (SOFA) and Chronic Liver Failure Consortium (CLIF)-SOFA scores, may be useful as an auxiliary tool in the decision-making process regarding the benefits of maintaining supportive therapies in this population. A CLIF-ACLF > 70 at admission or at day 3 was associated with a poor prognosis, as well as SOFA score > 19 at baseline or increasing SOFA score > 72. Additional studies addressing the prognostic assessment of these patients are necessary.
重症肝硬化患者住院死亡率高，由于需要多器官支持，会消耗大量医疗资源。尽管如此，近几十年来，由于对重症患者的护理有所改善，他们的死亡率有所下降。急性慢性肝衰竭（ACLF）、脓毒症和升高的肝脏评分与该人群死亡率增加相关，尤其是在那些不适合肝移植的患者中。在这些患者的预后评估中，没有哪种评分优于其他评分，肝脏特异性评分和重症监护病房特异性评分均具有令人满意的预测准确性。对这些评分进行序贯评估，尤其是序贯器官衰竭评估（SOFA）和慢性肝衰竭联盟（CLIF）-SOFA评分，可能作为辅助工具，用于决定是否对该人群维持支持性治疗。入院时或第3天CLIF-ACLF>70以及基线时SOFA评分>19或SOFA评分增加>72均与预后不良相关。有必要开展更多针对这些患者预后评估的研究。
