Department of Internal Medicine, St. Vincent's Hospital, The Catholic University of Korea, Seoul, Korea.
Department of Internal Medicine, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea.
Clin Mol Hepatol. 2024 Jul;30(3):388-405. doi: 10.3350/cmh.2023.0563. Epub 2024 Apr 11.
BACKGROUND/AIMS: Quick sequential organ failure assessment (qSOFA) is believed to identify patients at risk of poor outcomes in those with suspected infection. We aimed to evaluate the ability of modified qSOFA (m-qSOFA) to identify high-risk patients among those with acutely deteriorated chronic liver disease (CLD), especially those with acute-onchronic liver failure (ACLF).
We used data from both the Korean Acute-on-Chronic Liver Failure (KACLiF) and the Asian Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) cohorts. qSOFA was modified by replacing the Glasgow Coma Scale with hepatic encephalopathy, and an m-qSOFA ≥2 was considered high.
Patients with high m-qSOFA had a significantly lower 1-month transplant-free survival (TFS) in both cohorts and higher organ failure development in KACLiF than those with low m-qSOFA (Ps<0.05). Subgroup analysis by ACLF showed that patients with high m-qSOFA had lower TFS than those with low m-qSOFA. m-qSOFA was an independent prognostic factor (hazard ratios, HR=2.604, 95% confidence interval, CI 1.353-5.013, P=0.004 in KACLiF and HR=1.904, 95% CI 1.484- 2.442, P<0.001 in AARC). The patients with low m-qSOFA at baseline but high m-qSOFA on day 7 had a significantly lower 1-month TFS than those with high m-qSOFA at baseline but low m-qSOFA on day 7 (52.6% vs. 89.4%, P<0.001 in KACLiF and 26.9% vs. 61.5%, P<0.001 in AARC).
Baseline and dynamic changes in m-qSOFA may identify patients with a high risk of developing organ failure and short-term mortality among CLD patients with acute deterioration.
背景/目的：快速序贯器官衰竭评估（qSOFA）被认为可以识别出疑似感染患者中预后不良的风险患者。我们旨在评估改良 qSOFA（m-qSOFA）在急性慢性肝衰竭（ACLF）患者中识别高危患者的能力，特别是那些急性肝衰竭合并慢性肝病（ACLF）患者。
我们使用了来自韩国急性慢性肝衰竭（KACLiF）和亚太肝病研究协会 ACLF 研究联盟（AARC）队列的数据。通过用肝性脑病替代格拉斯哥昏迷量表来修改 qSOFA，将 m-qSOFA≥2 视为高值。
在两个队列中，m-qSOFA 高值患者的 1 个月无移植生存率（TFS）显著低于低值患者，并且 KACLiF 中的器官衰竭发展更高（P<0.05）。通过 ACLF 进行的亚组分析表明，m-qSOFA 高值患者的 TFS 低于低值患者。m-qSOFA 是一个独立的预后因素（KACLiF 中的危险比[HR]为 2.604，95%置信区间[CI]为 1.353-5.013，P=0.004；AARC 中的 HR 为 1.904，95%CI 为 1.484-2.442，P<0.001）。基线时 m-qSOFA 值低但第 7 天 m-qSOFA 值高的患者，其 1 个月 TFS 显著低于基线时 m-qSOFA 值高但第 7 天 m-qSOFA 值低的患者（KACLiF 中为 52.6%比 89.4%，P<0.001；AARC 中为 26.9%比 61.5%，P<0.001）。
m-qSOFA 的基线和动态变化可能可以识别出慢性肝病患者急性恶化时发生器官衰竭和短期死亡率风险较高的患者。
