Abudeif Ahmed, Sayed Eman Khalifa Al, Galal Ghada Moustapha
Department of Tropical Medicine and Gastroenterology, Sohag Faculty of Medicine, Sohag University, Egypt.
Clin Exp Hepatol. 2022 Dec;8(4):300-308. doi: 10.5114/ceh.2022.122332. Epub 2022 Dec 28.
We aimed to investigate the characteristics of acute-on-chronic liver failure (ACLF) and factors associated with 28-day mortality in patients with ACLF.
This prospective study included ACLF patients based on the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) Consortium criteria, admitted between March 2021 and February 2022. We examined variables associated with 28-day mortality using multivariate Cox regression analysis.
Of 326 patients admitted with acute decompensation (AD) of cirrhosis, 109 (33.44%) patients were diagnosed with ACLF (mean age 63.61 ±11.15 years, 65.14% males). Of these, 26.61%, 35.78%, and 37.61% of patients were in ACLF grades 1, 2, and 3 respectively. HCV (80.73%) was the main aetiology of cirrhosis. Upper gastrointestinal bleeding (25.69%) was the most common trigger. Kidney failure (73.39%) was the most common organ failure. The 28-day mortality rate was 66.97%. Cox regression analysis revealed that the existence of 2 (HR = 6.99, 95% CI: 2.68-18.25, < 0.0001) or ≥ 3 (HR = 9.34, 95% CI: 3.6-24.74, < 0.0001) organ failures, hepatic encephalopathy (HR = 2.96, 95% CI: 1.27-6.94, = 0.01), and elevated serum bilirubin (HR = 1.03, 95% CI: 1.00-1.06, = 0.04) were independent predictors for 28-day mortality, while shifting blood pH to the normal range was associated with a decrease in the HR of ACLF mortality (HR = 0.03, 95% CI: 0.002-0.44, = 0.01).
ACLF has a very high 28-day mortality, which is associated with the existence of 2 or more organ failures, hepatic encephalopathy, elevated serum bilirubin, and low blood pH.
我们旨在调查慢加急性肝衰竭（ACLF）的特征以及与ACLF患者28天死亡率相关的因素。
这项前瞻性研究纳入了根据欧洲肝脏研究协会慢性肝衰竭（EASL-CLIF）联盟标准诊断的ACLF患者，于2021年3月至2022年2月期间入院。我们使用多因素Cox回归分析检查与28天死亡率相关的变量。
在326例因肝硬化急性失代偿（AD）入院的患者中，109例（33.44%）被诊断为ACLF（平均年龄63.61±11.15岁，65.14%为男性）。其中，分别有26.61%、35.78%和37.61%的患者处于ACLF 1级、2级和3级。丙型肝炎病毒（80.73%）是肝硬化的主要病因。上消化道出血（25.69%）是最常见的诱因。肾衰竭（73.39%）是最常见的器官衰竭。28天死亡率为66.97%。Cox回归分析显示，存在2个（HR = 6.99，95%CI：2.68 - 18.25，<0.0001）或≥3个（HR = 9.34，95%CI：3.6 - 24.74，<0.0001）器官衰竭、肝性脑病（HR = 2.96，95%CI：1.27 - 6.94，= 0.01）以及血清胆红素升高（HR = 1.03，95%CI：1.00 - 1.06，= 0.04）是28天死亡率的独立预测因素，而将血液pH值恢复到正常范围与ACLF死亡率的HR降低相关（HR = 0.03，95%CI：0.002 - 0.44，= 0.01）。
ACLF的28天死亡率非常高，这与存在2个或更多器官衰竭、肝性脑病、血清胆红素升高以及低血pH值有关。
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