Department of Gastroenterology, Graduate School of Biomedical and Health Sciences, Hiroshima University, 1-2-3 Kasumi, Minami-Ku, Hiroshima, 734-8551, Japan.
Cancer Treatment Center, Hiroshima University Hospital, Hiroshima, Japan.
Hepatol Int. 2023 Oct;17(5):1225-1232. doi: 10.1007/s12072-023-10532-x. Epub 2023 Apr 26.
Heavy alcohol consumption is the most common etiology of acute-on-chronic liver failure (ACLF) in Japan. In some patients, ACLF is associated with a fatal outcome in less than 6 months. We evaluated the prognosis of patients with alcohol-related ACLF in our cohort and explored the prognostic factors.
Forty-six patients with alcoholic liver cirrhosis who fulfilled the Japanese diagnostic criteria for ACLF, including those classified as extended and/or probable, were enrolled in this study. Serum concentrations of inflammatory cytokines (interleukin [IL]-1β, IL-6, IL-8, IL-10, IL-12p70 and TNFα) were measured. We assessed prognosis and identified factors associated with survival.
During the median 33-day observation period, 19 patients died, and 3 patients underwent living donor liver transplantation. Cumulative survival rates of patients treated without liver transplantation were 69, 48, 41, and 36% at 1, 3, 6, and 12 months, respectively. Eighteen of the 19 deceased patients died within 6 months after ACLF diagnosis. Serum concentrations of inflammatory cytokines were significantly elevated, and patients who underwent liver transplantation or who died within 6 months after admission had significantly higher serum IL-6 levels than the survival group. Multivariate analysis identified IL-6 > 23.3 pg/mL at admission and model for end-stage liver disease (MELD) score ≥ 25 on day 4 of admission as significant independent factors for mortality within 6 months.
Serum IL-6 level and Day-4 MELD were prognostic factors for alcohol-related ACLF. Early liver transplantation is a potential treatment option for patients whose prognosis is expected to be poor.
在日本，大量饮酒是导致慢加急性肝衰竭（ACLF）的最常见病因。在某些患者中，ACLF 在不到 6 个月内导致致命后果。我们评估了我们队列中酒精相关 ACLF 患者的预后，并探讨了预后因素。
本研究纳入了 46 例符合日本 ACLF 诊断标准的酒精性肝硬化患者，包括扩展型和/或可能型 ACLF 患者。检测了炎症细胞因子（白细胞介素[IL]-1β、IL-6、IL-8、IL-10、IL-12p70 和 TNFα）的血清浓度。我们评估了预后并确定了与生存相关的因素。
在中位 33 天的观察期内，19 例患者死亡，3 例患者接受了活体供肝移植。未接受肝移植治疗的患者 1、3、6 和 12 个月的累积生存率分别为 69%、48%、41%和 36%。19 例死亡患者中有 18 例在 ACLF 诊断后 6 个月内死亡。炎症细胞因子的血清浓度明显升高，接受肝移植或入院后 6 个月内死亡的患者的血清 IL-6 水平明显高于存活组。多变量分析确定入院时的 IL-6>23.3pg/mL 和入院第 4 天的终末期肝病模型（MELD）评分≥25 是 6 个月内死亡的独立危险因素。
血清 IL-6 水平和第 4 天的 MELD 是酒精相关 ACLF 的预后因素。对于预计预后不良的患者，早期肝移植是一种潜在的治疗选择。
