Kumar Ashish, Arora Anil, Choudhury Ashok, Arora Vinod, Rela Mohamed, Jothimani Dinesh Kumar, Mahtab Mamun A, Devarbhavi Harshad, Eapen Chundamanni E, Goel Ashish, Yaghi Cesar, Ning Qin, Chen Tao, Jia Jidong, Zhongping Duan, Hamid Saeed S, Butt Amna S, Jafri Wasim, Shukla Akash, Tan Seok S, Kim Dong J, Saraya Anoop, Hu Jinhua, Sood Ajit, Goyal Omesh, Midha Vandana, Pati Girish K, Singh Ayaskant, Lee Guan H, Treeprasertsuk Sombat, Thanapirom Kessarin, Mandot Ameet, Maghade Ravikiran, Lesmana Rinaldi C, Ghazinyan Hasmik, Mohan Prasad Virukalpatti G, Dokmeci Abdul K, Sollano Jose D, Abbas Zaigham, Shrestha Ananta, Lau George K, Payawal Diana A, Shiha Gamal E, Duseja Ajay, Taneja Sunil, Verma Nipun, Rao Padaki N, Kulkarni Anand V, Karim Fazal, Saraswat Vivek A, Alam Shahinul, Chowdhury Debashis, Kedarisetty Chandan K, Saigal Sanjiv, Sharma Praveen, Yattoo Ghulam N, Koshy Abraham, Patwa Ajay K, Elbasiony Mohamed, Rathi Pravin M, Maharshi Sudhir, Dayal Vishwa M, Jha Ashish K, Kalista Kemal F, Gani Rino A, Yuen Man F, Singh Virendra, Sargsyan Violeta A, Huang Chien H, Mukewar Saurabh S, Xin Shaojie, Rajaram Ruveena B, Panackel Charles, Dadhich Sunil, Sachdeva Sanjeev, Kumar Ajay, Behera Sanatan, Kamani Lubna, Saithanyamurthi Hemamala V, Prasad Babita, Sarin Shiv K
Sir Ganga Ram Hospital, Rajender Nagar, New Delhi, India.
Institute of Liver and Biliary Sciences, New Delhi, India.
Am J Gastroenterol. 2025 Apr 1;120(4):816-826. doi: 10.14309/ajg.0000000000002951. Epub 2024 Jul 17.
The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and its complication, MAFLD-related acute-on-chronic liver failure (MAFLD-ACLF), is rising. Yet, factors determining patient outcomes in MAFLD-ACLF remain understudied.
Patients with MAFLD-ACLF were recruited from the Asian Pacific Association for the Study of the Liver-ACLF Research Consortium (AARC registry). The diagnosis of MAFLD-ACLF was made when the treating unit had identified the etiology of chronic liver disease as MAFLD (or previous nomenclature such as non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, or non-alcoholic steatohepatitis-cirrhosis). Patients with coexisting other etiologies of chronic liver disease (such as alcohol, hepatitis B virus, hepatitis C virus, etc.) were excluded. Data were randomly split into derivation (n = 258) and validation (n = 111) cohorts at a 70:30 ratio. The primary outcome was 90-day mortality. Only the baseline clinical, laboratory features and severity scores were considered.
The derivation group had 258 patients; 60% were male, with a mean age of 53. Diabetes was noted in 27% and hypertension in 29%. The dominant precipitants included viral hepatitis (hepatitis A virus and hepatitis E virus, 32%), drug-induced injury (drug-induced liver injury, 29%), and sepsis (23%). Model for End-Stage Liver Disease-Sodium (MELD-Na) and AARC scores on admission averaged 32 ± 6 and 10.4 ± 1.9. At 90 days, 51% survived. Nonviral precipitant, diabetes, bilirubin, international normalized ratio, and encephalopathy were independent factors influencing mortality. Adding diabetes and precipitant to MELD-Na and AARC scores, the novel MAFLD-MELD-Na score (+12 for diabetes, +12 for nonviral precipitant), and MAFLD-AARC score (+5 for each) were formed. These outperformed the standard scores in both cohorts.
Almost half of patients with MAFLD-ACLF die within 90 days. Diabetes and nonviral precipitants such as drug-induced liver injury and sepsis lead to adverse outcomes. The new MAFLD-MELD-Na and MAFLD-AARC scores provide reliable 90-day mortality predictions for patients with MAFLD-ACLF.
代谢功能障碍相关脂肪性肝病（MAFLD）及其并发症，即MAFLD相关慢加急性肝衰竭（MAFLD-ACLF）的患病率正在上升。然而，决定MAFLD-ACLF患者预后的因素仍未得到充分研究。
从亚太肝脏研究学会慢加急性肝衰竭研究联盟（AARC注册中心）招募MAFLD-ACLF患者。当治疗单位将慢性肝病的病因确定为MAFLD（或以前的命名，如非酒精性脂肪性肝病、非酒精性脂肪性肝炎或非酒精性脂肪性肝炎肝硬化）时，即可诊断为MAFLD-ACLF。排除同时存在其他慢性肝病病因（如酒精、乙型肝炎病毒、丙型肝炎病毒等）的患者。数据以70:30的比例随机分为推导队列（n = 258）和验证队列（n = 111）。主要结局为90天死亡率。仅考虑基线临床、实验室特征和严重程度评分。
推导队列有258例患者；60%为男性，平均年龄53岁。27%的患者有糖尿病，29%的患者有高血压。主要诱因包括病毒性肝炎（甲型肝炎病毒和戊型肝炎病毒，32%）、药物性损伤（药物性肝损伤，29%）和脓毒症（23%）。入院时终末期肝病钠模型（MELD-Na）和AARC评分平均分别为32±6和10.4±1.。在90天时，51%的患者存活。非病毒诱因、糖尿病、胆红素、国际标准化比值和肝性脑病是影响死亡率的独立因素。将糖尿病和诱因加入MELD-Na和AARC评分中，形成了新的MAFLD-MELD-Na评分（糖尿病加12分，非病毒诱因加12分）和MAFLD-AARC评分（每项加5分）。在两个队列中，这些评分均优于标准评分。
几乎一半的MAFLD-ACLF患者在90天内死亡。糖尿病和非病毒诱因，如药物性肝损伤和脓毒症，会导致不良结局。新的MAFLD-MELD-Na和MAFLD-AARC评分可为MAFLD-ACLF患者提供可靠的90天死亡率预测。
