人工肝支持系统治疗不同阶段慢性肝衰竭急性发作患者的疗效
Outcome of patients with different stages of acute-on-chronic liver failure treated with artificial liver support system.
作者信息
Ma Yuanji, Xu Yan, Du Lingyao, Bai Lang, Tang Hong
机构信息
Center of Infectious Diseases, West China Hospital of Sichuan University, Chengdu, China.
出版信息
Front Med (Lausanne). 2024 May 17;11:1381386. doi: 10.3389/fmed.2024.1381386. eCollection 2024.
BACKGROUND
Elevated international normalized ratio of prothrombin time (PT-INR) is one of the key characteristics of acute-on-chronic liver failure (ACLF). Whether the staging of PT-INR has the ability to screen out subgroups of ACLF patients who would be more eligible for artificial liver support system (ALSS) treatment has not been studied in detail.
METHODS
A previous study enrolled patients receiving ALSS treatment with regional citrate anticoagulation from January 2018 to December 2019. Patients with different PT-INR intervals were retrospectively enrolled: 1.3 ≤ PT-INR < 1.5 (Pre-stage), 1.5 ≤ PT-INR < 2.0 (Early-stage), 2.0 ≤ PT-INR < 2.5 (Mid-stage), and PT-INR ≥ 2.5 (End-stage). The Cox proportional hazards models were used to estimate the association between stages of ACLF or sessions of ALSS treatment and 90 day mortality.
RESULTS
A total of 301 ACLF patients were enrolled. The 90 day mortality risk of Early-stage ACLF patients (adjusted hazard ratio (aHR) (95% confidence interval (CI)), 3.20 (1.15-8.89), = 0.026), Mid-stage ACLF patients (3.68 (1.34-10.12), = 0.011), and End-stage ACLF patients (12.74 (4.52-35.91), < 0.001) were higher than that of Pre-stage ACLF patients, respectively. The 90 day mortality risk of Mid-stage ACLF patients was similar to that of Early-stage ACLF patients (1.15 (0.69-1.94), = 0.591). The sessions of ALSS treatment was an independent protective factor (aHR (95% CI), 0.81 (0.73-0.90), < 0.001). The 90 day mortality risk in ACLF patients received 3-5 sessions of ALSS treatment was lower than that of patients received 1-2 sessions (aHR (95% CI), 0.34 (0.20-0.60), < 0.001), whereas the risk in patients received ≥6 sessions of ALSS treatment was similar to that of patients received 3-5 sessions (0.69 (0.43-1.11), = 0.128).
CONCLUSION
ACLF patients in Pre-, Early-, and Mid-stages might be more eligible for ALSS treatment. Application of 3-5 sessions of ALSS treatment might be reasonable.
背景
凝血酶原时间国际标准化比值（PT-INR）升高是慢加急性肝衰竭（ACLF）的关键特征之一。PT-INR分期是否有能力筛选出更适合人工肝支持系统（ALSS）治疗的ACLF患者亚组，尚未进行详细研究。
方法
一项既往研究纳入了2018年1月至2019年12月接受局部枸橼酸抗凝ALSS治疗的患者。回顾性纳入不同PT-INR区间的患者：1.3≤PT-INR＜1.5（前期）、1.5≤PT-INR＜2.0（早期）、2.0≤PT-INR＜2.5（中期）和PT-INR≥2.5（末期）。采用Cox比例风险模型评估ACLF分期或ALSS治疗疗程与90天死亡率之间的关联。
结果
共纳入301例ACLF患者。早期ACLF患者（校正风险比（aHR）（95%置信区间（CI）），3.20（1.15 - 8.89），P = 0.026）、中期ACLF患者（3.68（1.34 - 10.12），P = 0.011）和末期ACLF患者（12.74（4.52 - 35.91），P＜0.001）的90天死亡风险分别高于前期ACLF患者。中期ACLF患者的90天死亡风险与早期ACLF患者相似（1.15（0.69 - 1.94），P = 0.591）。ALSS治疗疗程是一个独立的保护因素（aHR（95%CI），0.81（0.73 - 0.90），P＜0.001）。接受3 - 5次ALSS治疗的ACLF患者90天死亡风险低于接受1 - 2次治疗的患者（aHR（95%CI），0.34（0.20 - 0.60），P＜0.001），而接受≥6次ALSS治疗的患者风险与接受3 - 5次治疗的患者相似（0.69（0.43 - 1.11），P = 0.128）。
结论
前期、早期和中期ACLF患者可能更适合ALSS治疗。应用3 - 5次ALSS治疗可能是合理的。
Zotero 插件