Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Thai Red Cross, King Chulalongkorn Memorial Hospital, Chulalongkorn University, Pathumwan, Bangkok, Thailand.
Liver Fibrosis and Cirrhosis Research Unit, Chulalongkorn University, Bangkok, Thailand.
Hepatol Int. 2022 Feb;16(1):171-182. doi: 10.1007/s12072-021-10266-8. Epub 2021 Nov 25.
Acute-on-chronic liver failure (ACLF) is considered a main prognostic event in patients with chronic liver disease (CLD). We analyzed the 28-day and 90-day mortality in ACLF patients with or without underlying cirrhosis enrolled in the ACLF Research Consortium (AARC) database.
A total of 1,621 patients were prospectively enrolled and 637 (39.3%) of these patients had cirrhosis. Baseline characteristics, complications and mortality were compared between patients with and without cirrhosis.
Alcohol consumption was more common in cirrhosis than non-cirrhosis (66.4% vs. 44.2%, p < 0.0001), while non-alcoholic fatty liver disease/cryptogenic CLD (10.9% vs 5.8%, p < 0.0001) and chronic HBV reactivation (18.8% vs 11.8%, p < 0.0001) were more common in non-cirrhosis. Only 0.8% of patients underwent liver transplantation. Overall, 28-day and 90-day mortality rates were 39.3% and 49.9%, respectively. Patients with cirrhosis had a greater chance of survival compared to those without cirrhosis both at 28-day (HR = 0.48; 95% CI 0.36-0.63, p < 0.0001) and 90-day (HR = 0.56; 95% CI 0.43-0.72, p < 0.0001), respectively. In alcohol CLD, non-cirrhosis patients had a higher 28-day (49.9% vs. 23.6%, p < 0.001) and 90-day (58.4% vs. 35.2%, p < 0.001) mortality rate than cirrhosis patients. ACLF patients with cirrhosis had longer mean survival than non-cirrhosis patients (25.5 vs. 18.8 days at 28-day and 65.2 vs. 41.2 days at 90-day). Exaggerated systemic inflammation might be the reason why non-cirrhosis patients had a poorer prognosis than those with cirrhosis after ACLF had occurred.
The 28-day and 90-day mortality rates of ACLF patients without cirrhosis were significantly higher than those with cirrhosis in alcoholic CLD. The presence of cirrhosis and its stage should be evaluated at baseline to guide for management. Thai Clinical Trials Registry, TCTR20191226002.
急性肝衰竭合并慢性肝病（ACLF）被认为是慢性肝病（CLD）患者的主要预后事件。我们分析了急性肝衰竭研究联盟（AARC）数据库中合并或不合并肝硬化的 ACLF 患者的 28 天和 90 天死亡率。
共前瞻性纳入 1621 例患者，其中 637 例（39.3%）患者合并肝硬化。比较肝硬化与非肝硬化患者的基线特征、并发症和死亡率。
与非肝硬化患者相比，肝硬化患者更常饮酒（66.4% vs. 44.2%，p<0.0001），而非酒精性脂肪性肝病/隐匿性 CLD（10.9% vs. 5.8%，p<0.0001）和慢性乙型肝炎再激活（18.8% vs. 11.8%，p<0.0001）更常见于非肝硬化患者。仅有 0.8%的患者接受了肝移植。总体而言，28 天和 90 天死亡率分别为 39.3%和 49.9%。与非肝硬化患者相比，肝硬化患者在 28 天（HR=0.48；95%CI 0.36-0.63，p<0.0001）和 90 天（HR=0.56；95%CI 0.43-0.72，p<0.0001）时均有更高的生存机会。在酒精性 CLD 中，非肝硬化患者的 28 天（49.9% vs. 23.6%，p<0.001）和 90 天（58.4% vs. 35.2%，p<0.001）死亡率均高于肝硬化患者。肝硬化 ACLF 患者的平均生存时间长于非肝硬化患者（28 天时为 25.5 天 vs. 18.8 天，90 天时为 65.2 天 vs. 41.2 天）。可能是过度的全身炎症导致非肝硬化患者在发生 ACLF 后预后比肝硬化患者更差。
在酒精性 CLD 中，非肝硬化 ACLF 患者的 28 天和 90 天死亡率明显高于肝硬化患者。应在基线时评估肝硬化及其分期，以指导治疗。泰国临床试验注册中心，TCTR20191226002。
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