Hafsa Fatima, Chaudary Zao Iman, Tariq Owais, Riaz Zainab, Shehzad Aamir, Irfan Jamil Muhammad, Naeem Iqra
Gastroenterology, Lahore General Hospital, Lahore, Lahore, PAK.
Internal Medicine, Doctors Hospital Lahore, Lahore, PAK.
Cureus. 2024 Jan 21;16(1):e52690. doi: 10.7759/cureus.52690. eCollection 2024 Jan.
Objectives This study aimed to identify the causes, clinical characteristics, and 28-day in-hospital mortality predictors in patients with acute-on-chronic liver failure (ACLF). Methods A cross-sectional study enrolled sixty-four patients aged 18-70 years with acute-on-chronic liver failure. The study was conducted at the Gastroenterology Department, Lahore General Hospital. The study classified ACLF according to the criteria of the European Association for the Study of the Liver - Chronic Liver Failure (EASL-CLIF). Patients were followed for 28 days for mortality outcomes. The outcomes between Survivor and Non-survivor groups were compared using the Chi-Square/Fisher's Exact Test for categorical variables and the Mann-Whitney U test for continuous variables. Results In this study, age and duration of chronic liver disease were not significantly different between survivors and non-survivors. The etiology of liver disease and ACLF causes had no impact on 28-day mortality. Non-survivors had lower mean arterial pressure, and higher mortality was linked with lower Glasgow Coma Scale scores, upper gastrointestinal bleeding, and Grade IV hepatic encephalopathy. Significant differences in bilirubin, serum creatinine, urea, and C-reactive protein levels were observed at 28 days. Survival rates were highest with single organ failure (35.94%) and decreased with multiple organ failures. The overall survival rate was 51.56%. Predictive validity for mortality was assessed using the Area Under the Curve (AUC), with Child-Turcotte-Pugh (CTP) at 0.679, Model for End-Stage Liver Disease (MELD) at 0.819, and Chronic Liver Failure-Sequential Organ Failure Assessment (CLIF-SOFA) at 0.771. Conclusion This study concludes that in acute-on-chronic liver failure, factors like age, gender, and disease etiology do not significantly predict 28-day mortality. Key mortality indicators include clinical parameters such as lower Glasgow Coma Scale scores, hepatic encephalopathy Grade IV, and laboratory findings like elevated bilirubin and serum creatinine. The MELD score is the most compelling prognostic tool.
目的 本研究旨在确定慢加急性肝衰竭（ACLF）患者的病因、临床特征及28天院内死亡的预测因素。方法 一项横断面研究纳入了64例年龄在18至70岁之间的慢加急性肝衰竭患者。该研究在拉合尔综合医院胃肠病科进行。研究根据欧洲肝脏研究协会-慢性肝衰竭（EASL-CLIF）标准对ACLF进行分类。对患者进行28天的随访以获取死亡结局。使用卡方检验/费舍尔精确检验比较生存组和非生存组之间的分类变量，使用曼-惠特尼U检验比较连续变量。结果 在本研究中，幸存者和非幸存者之间的年龄及慢性肝病病程无显著差异。肝病病因和ACLF病因对28天死亡率无影响。非幸存者的平均动脉压较低，较低的格拉斯哥昏迷量表评分、上消化道出血和IV级肝性脑病与较高的死亡率相关。在28天时观察到胆红素、血清肌酐、尿素和C反应蛋白水平存在显著差异。单器官衰竭的生存率最高（35.94%），多器官衰竭时生存率降低。总体生存率为51.56%。使用曲线下面积（AUC）评估死亡率的预测效度，Child-Turcotte-Pugh（CTP）评分的AUC为0.679，终末期肝病模型（MELD）的AUC为0.819，慢性肝衰竭-序贯器官衰竭评估（CLIF-SOFA）的AUC为0.771。结论 本研究得出结论，在慢加急性肝衰竭中，年龄、性别和疾病病因等因素不能显著预测28天死亡率。关键的死亡指标包括临床参数，如较低的格拉斯哥昏迷量表评分、IV级肝性脑病，以及实验室检查结果，如胆红素和血清肌酐升高。MELD评分是最具说服力的预后工具。
