Centre for Neuroscience, Trauma and Surgery, Wingate Institute of Neurogastroenterology, The Blizard Institute, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
Liver Failure Group, University College London Medical School, Royal Free Hospital Campus, London, UK.
Aliment Pharmacol Ther. 2023 Oct;58(8):774-794. doi: 10.1111/apt.17659. Epub 2023 Aug 17.
Acute-on-chronic liver failure (ACLF) is a clinically and pathophysiologically distinct condition from acutely decompensated cirrhosis and is characterised by systemic inflammation, extrahepatic organ failure, and high short-term mortality.
To provide a narrative review of the diagnostic criteria, prognosis, epidemiology, and general management principles of ACLF. Four specific interventions that are explored in detail are intravenous albumin, extracorporeal liver assist devices, granulocyte-colony stimulating factor, and liver transplantation.
We searched PubMed and Cochrane databases for articles published up to July 2023.
Approximately 35% of hospital inpatients with decompensated cirrhosis have ACLF. There is significant heterogeneity in the criteria used to diagnose ACLF; different definitions identify different phenotypes with varying mortality. Criteria established by the European Association for the Study of the Liver were developed in prospective patient cohorts and are, to-date, the most well validated internationally. Systemic haemodynamic instability, renal dysfunction, coagulopathy, neurological dysfunction, and respiratory failure are key considerations when managing ACLF in the intensive care unit. Apart from liver transplantation, there are no accepted evidence-based treatments for ACLF, but several different approaches are under investigation.
The recognition of ACLF as a distinct entity from acutely decompensated cirrhosis has allowed for better patient stratification in clinical settings, facilitating earlier engagement with the intensive care unit and liver transplantation teams. Research priorities over the next decade should focus on exploring novel treatment strategies with a particular focus on which, when, and how patients with ACLF should be treated.
慢加急性肝衰竭（ACLF）是一种与急性失代偿性肝硬化在临床和病理生理学上有明显区别的疾病，其特点是全身炎症、肝外器官衰竭和高短期死亡率。
提供关于 ACLF 的诊断标准、预后、流行病学和一般管理原则的叙述性综述。详细探讨了四种特定的干预措施：静脉注射白蛋白、体外肝辅助装置、粒细胞集落刺激因子和肝移植。
我们在 PubMed 和 Cochrane 数据库中搜索了截至 2023 年 7 月发表的文章。
约 35%的失代偿性肝硬化住院患者患有 ACLF。用于诊断 ACLF 的标准存在显著异质性；不同的定义确定了具有不同死亡率的不同表型。由欧洲肝脏研究协会制定的标准是在前瞻性患者队列中建立的，迄今为止在国际上得到了最好的验证。在重症监护病房中管理 ACLF 时，需要考虑全身血流动力学不稳定、肾功能障碍、凝血功能障碍、神经功能障碍和呼吸衰竭。除肝移植外，ACLF 没有公认的循证治疗方法，但有几种不同的方法正在研究中。
将 ACLF 视为与急性失代偿性肝硬化不同的实体，使得在临床环境中能够更好地对患者进行分层，从而更早地与重症监护室和肝移植团队接触。未来十年的研究重点应放在探索新的治疗策略上，特别是应特别关注哪些 ACLF 患者应该接受治疗、何时以及如何治疗。
