Juanola Adrià, Tiwari Neha, Solé Cristina, Adebayo Danielle, Wong Florence, Ginès Pere
Liver Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Liver Int. 2025 Mar;45(3):e15622. doi: 10.1111/liv.15622. Epub 2023 May 24.
Acute-on-chronic liver failure (ACLF) is a complex syndrome defined by the existence of different organ failures (OFs) in patients with chronic liver disease, mainly cirrhosis. Several definitions have been proposed to define the syndrome, varying in the grade of the subjacent liver disease, the type of precipitants and the organs considered in the definition. Liver, coagulation, brain, kidney, circulatory and pulmonary are the six types of OFs proposed in the different classifications, with different prevalence worldwide. Irrespective of the definition used, patients who develop ACLF present a hyperactive immune system, profound haemodynamic disturbances and several metabolic alterations that finally lead to organ dysfunction. These disturbances are triggered by different factors such as bacterial infections, alcoholic hepatitis, gastrointestinal bleeding or hepatitis B virus flare, among others. Because patients with ACLF present high short-term mortality, a prompt recognition is needed to start treatment of the trigger event and specific organ support. Liver transplantation is also feasible in carefully selected patients and should be evaluated.
慢加急性肝衰竭（ACLF）是一种复杂的综合征，定义为慢性肝病（主要是肝硬化）患者出现不同器官功能衰竭（OF）。为定义该综合征已提出了几种定义，在基础肝病的分级、诱发因素的类型以及定义中所考虑的器官方面存在差异。肝脏、凝血、脑、肾、循环和肺是不同分类中提出的六种OF类型，在全球范围内患病率不同。无论使用何种定义，发生ACLF的患者都表现出免疫系统亢进、严重的血流动力学紊乱和多种代谢改变，最终导致器官功能障碍。这些紊乱由不同因素触发，如细菌感染、酒精性肝炎、胃肠道出血或乙型肝炎病毒复发等。由于ACLF患者短期死亡率高，需要迅速识别以开始对触发事件进行治疗并给予特定器官支持。在经过精心挑选的患者中，肝移植也是可行的，应予以评估。
