Igna Răzvan, Muzica Cristina, Zenovia Sebastian, Minea Horia, Girleanu Irina, Huiban Laura, Trifan Anca
Intensive Care Unit, "Sf. Spiridon" University Hospital, Iasi, Romania.
Department of Gastroenterology, "Grigore T. Popa" University of Medicine and Pharmacy, Iasi, Romania.
Arch Clin Cases. 2024 Jul 16;11(2):61-68. doi: 10.22551/2024.43.1102.10290. eCollection 2024.
Acute on chronic liver failure (ACLF) is typically characterized by a rapid progression of liver failure in patients with liver cirrhosis and it is triggered by a precipitant factor, usually a bacterial infection (BI). Considering the low accuracy of the inflammation biomarkers in liver cirrhosis, presepsin and procalcitonin have demonstrated a good diagnostic performance for BI. Understanding the key prognostic factors that influence patient outcomes can significantly impact clinical decision-making and improve patient care in ACLF which can lead to lower mortality rates. To evaluate the prognostic factors associated with 30-day mortality in patients with alcohol-related liver cirrhosis and ACLF. This retrospective study on 227 patients diagnosed with ACLF and alcohol-related liver cirrhosis analyzed the prognostic role of presepsin and procalcitonin serum levels. The survival analysis according to the grade of ACLF showed that more than 80% of patients with ACLF grade 1 survived after 30 days, with a mean estimated time of death of 29 ±0.44 days (95 % CI: 28.17-29.92) compared to ACLF grade 2 (24.9±1.064 days; 95 % CI: 22.82-26.99) and ACLF grade 3 (21.05±1.17 days; 95 % CI: 18.75-23.34), with a mean overall survival on entire cohort of 25.69±0.52 days (95 % CI: 24.65-26.73). Presepsin (OR: 4.008, CI 95:3.130-6.456, p=0.001) and procalcitonin (OR: 3.666, CI 95:2.312-5.813, p=0.001) were the most significant factors associated with 30-day mortality. In ACLF grade 2, presepsin provides a better prediction of mortality at the cutoff value of 1050 pg/mL (Sensitivity 72%, Specificity 69%) than procalcitonin (AUC=0.727 95% CI 0.594-0.860, p<0.002) whereas in ACLF grade 3, a cutoff of 1450 pg/mL (Sensitivity 89%, Specificity 91%) presepsin had a more significant accuracy of mortality prediction (AUC=0.93 95% CI 0.81-0.99, p<0.001) than procalcitonin (AUC=0.731 95% CI 0.655-0.807, p<0.001). ACLF is associated with a high mortality rate and the risk of death increases with the grade of ACLF. Presepsin and procalcitonin serum levels are good prognostic factors for 30-day mortality and should be used in clinical practice to stratify the risk and provide and early and efficient treatment in patients with ACLF.
慢加急性肝衰竭（ACLF）的典型特征是肝硬化患者肝功能迅速恶化，通常由促发因素引发，常见的是细菌感染（BI）。鉴于肝硬化炎症生物标志物的准确性较低，可溶性髓系细胞触发受体-1（presepsin）和降钙素原在细菌感染方面已显示出良好的诊断性能。了解影响患者预后的关键因素对临床决策具有重大影响，并可改善ACLF患者的护理，进而降低死亡率。本研究旨在评估酒精性肝硬化合并ACLF患者30天死亡率的相关预后因素。这项针对227例诊断为ACLF和酒精性肝硬化患者的回顾性研究，分析了presepsin和降钙素原血清水平的预后作用。根据ACLF分级进行的生存分析显示，超过80%的1级ACLF患者在30天后存活，平均估计死亡时间为29±0.44天（95%CI：28.17-29.92），而2级ACLF患者为（24.9±1.064天；95%CI：22.82-26.99），3级ACLF患者为（21.05±1.17天；95%CI：18.75-23.34），整个队列的平均总生存期为25.69±0.52天（95%CI：24.65-26.73）。Presepsin（OR：4.008，95%CI：3.130-6.456，p=0.001）和降钙素原（OR：3.666，95%CI：2.312-5.813，p=0.001）是与30天死亡率相关的最显著因素。在2级ACLF中，presepsin在截断值为1050 pg/mL时对死亡率的预测优于降钙素原（敏感性72%，特异性69%）（AUC=0.727，95%CI：0.594-0.860，p<0.002），而在3级ACLF中，截断值为1450 pg/mL时（敏感性89%，特异性91%），presepsin对死亡率的预测准确性（AUC=0.93，95%CI：0.81-0.99，p<0.001）高于降钙素原（AUC=0.731，95%CI：0.655-0.807，p<0.001）。ACLF与高死亡率相关且死亡风险随ACLF分级增加。Presepsin和降钙素原血清水平是30天死亡率的良好预后因素，应在临床实践中用于分层风险，并为ACLF患者提供早期有效治疗。
