Sturm Lukas, Reincke Marlene, Bettinger Dominik
Klinik für Innere Medizin II, Universitätsklinikum Freiburg, Medizinische Fakultät, Albert-Ludwigs-Universität, Freiburg.
Dtsch Med Wochenschr. 2022 Jun;147(11):662-669. doi: 10.1055/a-1671-9114. Epub 2022 May 30.
Acute decompensation and acute-on chronic liver failure (ACLF) are associated with a significant reduced prognosis. Previously, the pathophysiological concept of acute decompensation was mainly based on the peripheral vasodilatation hypothesis. However, during the last years, systemic inflammation was recognized as a major driver for decompensation of liver cirrhosis and ACLF. Further, it has been shown that systemic inflammation is associated with the clinical course and the prognosis of the patients. Inflammation also affects the function of extrahepatic organs and therefore leads to the development of an inflammatory cirrhotic multi-organ syndrome. The importance of systemic inflammation in the context of decompensated liver cirrhosis is also transferred to new clinical scores such as the CLIF-C AD and CLIF-C ACLF score. In this article, we provide an overview of the new systemic inflammation hypothesis of decompensated cirrhosis and also discuss current clinical scores for prognostication in different stages of liver cirrhosis.
急性失代偿和慢加急性肝衰竭（ACLF）与预后显著降低相关。以前，急性失代偿的病理生理概念主要基于外周血管扩张假说。然而，在过去几年中，全身炎症被认为是肝硬化和ACLF失代偿的主要驱动因素。此外，已表明全身炎症与患者的临床病程和预后相关。炎症还影响肝外器官的功能，因此导致炎性肝硬化多器官综合征的发生。全身炎症在失代偿期肝硬化背景下的重要性也被纳入新的临床评分，如CLIF-C AD和CLIF-C ACLF评分。在本文中，我们概述了失代偿期肝硬化的新的全身炎症假说，并讨论了肝硬化不同阶段预后评估的当前临床评分。
