Departamento de Gastroenterología, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Departamento de Ciencias de la Salud, Facultad de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile.
Gastroenterol Hepatol. 2024 Jun-Jul;47(6):562-573. doi: 10.1016/j.gastrohep.2023.09.006. Epub 2023 Sep 29.
Acute-on-chronic liver failure (ACLF) is a severe clinical entity associated with elevated short-term mortality. We aimed to characterize patients with decompensated cirrhosis according to presence of ACLF, their association with active alcohol intake, and long-term survival in Latin America.
Retrospective cohort study of decompensated cirrhotic in three Chilean university centers (2017-2019). ACLF was diagnosed according EASL-CLIF criteria. We assessed survival using competing-risk and time-to-event analyses. We evaluated the time to death using accelerated failure time (AFT) models.
We included 320 patients, median age of 65.3±11.7 years old, and 48.4% were women. 92 (28.7%) patients met ACLF criteria (ACLF-1: 29.3%, ACLF-2: 27.1%, and ACLF-3: 43.4%). The most common precipitants were infections (39.1%), and the leading organ failure was kidney (59.8%). Active alcohol consumption was frequent (27.7%), even in patients with a prior diagnosis of non-alcoholic fatty liver disease (NAFLD) (16.2%). Ninety-two (28.7%) patients had ACLF (ACLF-1: 8.4%, ACLF-2: 7.8%, and ACLF-3: 12.5%). ACLF patients had a higher MELD-Na score at admission (27 [22-31] versus 16 [12-21], p<0.0001), a higher frequency of alcohol-associated liver disease (36.7% versus 24.9%, p=0.039), and a more frequent active alcohol intake (37.2% versus 23.8%, p=0.019). In a multivariate model, ACLF was associated with higher mortality (subdistribution hazard ratio 1.735, 95%CI: 1.153-2.609; p<0.008). In the AFT models, the presence of ACLF during hospitalization correlated with a shorter time to death: ACLF-1 shortens the time to death by 4.7 times (time ratio [TR] 0.214, 95%CI: 0.075-0.615; p<0.004), ACLF-2 by 4.4 times (TR 0.224, 95%CI: 0.070-0.713; p<0.011), and ACLF-3 by 37 times (TR 0.027, 95%CI: 0.006-0.129; p<0.001).
Patients with decompensated cirrhosis and ACLF exhibited a high frequency ofactive alcohol consumption. Patients with ACLF showed higher mortality and shorter time todeath than those without ACLF.
急性肝衰竭（ACLF）是一种与短期死亡率升高相关的严重临床实体。我们旨在根据 ACLF 的存在、与活跃饮酒的关联以及拉丁美洲的长期生存情况，对失代偿性肝硬化患者进行特征描述。
对三个智利大学中心（2017-2019 年）的失代偿性肝硬化患者进行回顾性队列研究。根据 EASL-CLIF 标准诊断 ACLF。我们使用竞争风险和时间事件分析评估生存率。我们使用加速失效时间（AFT）模型评估死亡时间。
我们纳入了 320 名患者，中位年龄为 65.3±11.7 岁，48.4%为女性。92 名（28.7%）患者符合 ACLF 标准（ACLF-1：29.3%，ACLF-2：27.1%，ACLF-3：43.4%）。最常见的诱因是感染（39.1%），主要的器官衰竭是肾脏（59.8%）。活跃的饮酒行为很常见（27.7%），即使在有非酒精性脂肪性肝病（NAFLD）既往诊断的患者中也是如此（16.2%）。92 名（28.7%）患者有 ACLF（ACLF-1：8.4%，ACLF-2：7.8%，ACLF-3：12.5%）。ACLF 患者入院时 MELD-Na 评分更高（27[22-31]与 16[12-21]，p<0.0001），酒精相关性肝病的频率更高（36.7%与 24.9%，p=0.039），活跃的饮酒行为更频繁（37.2%与 23.8%，p=0.019）。多变量模型显示，ACLF 与更高的死亡率相关（亚分布风险比 1.735，95%CI：1.153-2.609；p<0.008）。在 AFT 模型中，住院期间 ACLF 的存在与死亡时间缩短相关：ACLF-1 将死亡时间缩短了 4.7 倍（时间比[TR]0.214，95%CI：0.075-0.615；p<0.004），ACLF-2 缩短了 4.4 倍（TR 0.224，95%CI：0.070-0.713；p<0.011），ACLF-3 缩短了 37 倍（TR 0.027，95%CI：0.006-0.129；p<0.001）。
失代偿性肝硬化合并 ACLF 的患者有较高的活跃饮酒行为。与无 ACLF 患者相比，有 ACLF 的患者死亡率更高，死亡时间更短。
