Patwa Ajay K, Yadav Khushboo, Atam Virendra, Usman Kauser, Sonkar Satyendra K, Chaudhary Shyam C, Kumar Vivek, Sawlani Kamal K, Gupta Kamlesh K, Patel Munna L, Reddy Dandu H, Gupta Harish, Gautam Medhavi, Kumar Satish, Kumar Amit, Yadav Ambuj, Bhagchandani Deepak, Lamba Mahak, Singh Abhishek, Mishra Ajay K
Gastroenterology and Hepatology Unit, Department of Medicine, King George's Medical University, Lucknow, India.
Department of Medicine, King George's Medical University, Lucknow, India.
J Clin Exp Hepatol. 2024 Jul-Aug;14(4):101366. doi: 10.1016/j.jceh.2024.101366. Epub 2024 Feb 23.
Commonly used prognostic scores for acute on-chronic liver failure (ACLF) have complex calculations. We tried to compare the simple counting of numbers and types of organ dysfunction to these scores, to predict mortality in ACLF patients.
In this prospective cohort study, ACLF patients diagnosed on the basis of Asia Pacific Association for Study of the Liver (APASL) definition were included. Severity scores were calculated. Prognostic factors for outcome were analysed. A new score, the Number of Organ Dysfunctions in Acute-on-Chronic Liver Failure (NOD-ACLF) score was developed.
Among 80 ACLF patients, 74 (92.5%) were male, and 6 were female (7.5%). The mean age was 41.0±10.7 (18-70) years. Profile of acute insult was; alcohol 48 (60%), sepsis 30 (37.5%), variceal bleeding 22 (27.5%), viral 8 (10%), and drug-induced 3 (3.8%). Profiles of chronic insults were alcohol 61 (76.3%), viral 20 (25%), autoimmune 3 (3.8%), and non-alcoholic steatohepatitis 2 (2.5%). Thirty-eight (47.5%) were discharged, and 42 (52.5%) expired. The mean number of organ dysfunction (NOD-ACLF score) was ->4.5, simple organ failure count (SOFC) score was >2.5, APASL ACLF Research Consortium score was >11.5, Model for End-Stage Liver Disease-Lactate (MELD-LA) score was >21.5, and presence of cardiovascular and respiratory dysfunctions were significantly associated with mortality. NOD-ACLF and SOFC scores had the highest area under the receiver operating characteristic to predict mortality among all these.
The NOD-ACLF score is easy to calculate bedside and is a good predictor of mortality in ACLF patients performing similar or better to other scores.
常用的急性慢性肝衰竭（ACLF）预后评分计算复杂。我们试图将器官功能障碍的数量和类型的简单计数与这些评分进行比较，以预测ACLF患者的死亡率。
在这项前瞻性队列研究中，纳入了根据亚太肝脏研究协会（APASL）定义诊断的ACLF患者。计算严重程度评分。分析预后结局的因素。开发了一种新的评分，即急性慢性肝衰竭器官功能障碍数量（NOD-ACLF）评分。
80例ACLF患者中，74例（92.5%）为男性，6例为女性（7.5%）。平均年龄为41.0±10.7（18 - 70）岁。急性损伤情况为：酒精性48例（60%），脓毒症30例（37.5%），静脉曲张出血22例（27.5%），病毒性8例（10%），药物性3例（3.8%）。慢性损伤情况为：酒精性61例（76.3%），病毒性20例（25%），自身免疫性3例（3.8%），非酒精性脂肪性肝炎2例（2.5%）。38例（47.5%）出院，42例（52.5%）死亡。器官功能障碍的平均数量（NOD-ACLF评分）>4.5，简单器官衰竭计数（SOFC）评分>2.5，APASL ACLF研究联盟评分>11.5，终末期肝病-乳酸模型（MELD-LA）评分>21.5，心血管和呼吸功能障碍的存在与死亡率显著相关。在所有这些评分中，NOD-ACLF和SOFC评分在预测死亡率方面具有最高的受试者工作特征曲线下面积。
NOD-ACLF评分易于在床边计算，并且是ACLF患者死亡率的良好预测指标，其表现与其他评分相似或更好。
