Hepatology and Gastroenterology Unit, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
Hôpitaux Universitaires de Strasbourg, 67000, Strasbourg, France.
Intensive Care Med. 2023 Aug;49(8):903-921. doi: 10.1007/s00134-023-07149-x. Epub 2023 Aug 8.
Acute-on-chronic liver failure (ACLF) is a clinical syndrome defined by an acute deterioration of the liver function associated with extrahepatic organ failures requiring intensive care support and associated with a high short-term mortality. ACLF has emerged as a major cause of mortality in patients with cirrhosis and chronic liver disease. ACLF has a unique pathophysiology in which systemic inflammation plays a key role; this provides the basis of novel therapies, several of which are now in clinical trials. Intensive care unit (ICU) therapy parallels that applied in the general ICU population in some organ failures but has peculiar differential characteristics in others. Critical care management strategies and the option of liver transplantation (LT) should be balanced with futility considerations in those with a poor prognosis. Nowadays, LT is the only life-saving treatment that can radically improve the long-term prognosis of patients with ACLF. This narrative review will provide insights on the current understanding of ACLF with emphasis on intensive care management.
急性慢性肝衰竭（ACLF）是一种临床综合征，其定义为肝功能急性恶化，伴有需要重症监护支持的肝外器官衰竭，并伴有高短期死亡率。ACLF 已成为肝硬化和慢性肝病患者死亡的主要原因。ACLF 的病理生理学独特，其中全身炎症起着关键作用；这为新型疗法提供了基础，其中一些正在临床试验中。在某些器官衰竭中，重症监护病房（ICU）治疗与普通 ICU 人群中的治疗相似，但在其他方面具有特殊的差异特征。在预后不良的患者中，应平衡重症监护管理策略和肝移植（LT）的选择与无效性考虑。如今，LT 是唯一可以从根本上改善 ACLF 患者长期预后的救命治疗方法。本叙述性综述将提供对 ACLF 的当前理解的见解，重点是重症监护管理。
