Skladaný Ľubomír, Líška Dávid, Mesiková Klaudia, Havaj Daniel, Adamcová-Selčanová Sveltana, Šulejová Karolína, Žilinčanová Daniela, Kohout Pavel
Department of Hepatology, Gastroenterology, and Transplantation, 2nd Department of Medicine, Slovak Medical University Faculty of Medicine, F. D. Roosevelt Hospital, Banska Bystrica, Slovakia.
Faculty of Sport Science and Health, Matej Bel University, Banska Bystrica, Slovakia
BMJ Open. 2025 May 28;15(5):e100171. doi: 10.1136/bmjopen-2025-100171.
Hospital admissions for advanced chronic liver disease (ACLD) are associated with increased mortality, disability, a decline in quality of life and significant economic costs. Being admitted to the hospital usually indicates a triggering event that disrupted a previously stable condition, leading to decompensation or complications of ACLD. The most acute and severe manifestation of this imbalance is acute-on-chronic liver failure (ACLF), a syndrome representing a critical juncture. Reliable prognostic stratification of patients admitted with ACLF could facilitate the systematic delivery of tailored care, ranging from palliative care to intensive interventions like extracorporeal liver support devices and prioritised liver transplantation. Disease-specific prognostic tools, such as the Model for End-Stage Liver Disease score, are effective but have limitations, particularly in reflecting a patient's potential for recovery. The concept of the body's functional reserve in the context of ACLD/ACLF is gaining attention, with the Liver Frailty Index (LFI) potentially emerging as a recommended diagnostic tool.
Patients were selected from our cirrhosis registry (RH7). The LFI serves as an indicator of the patient's prognosis. The LFI measurement takes place at two time intervals: on the patient's admission and after 7 days of hospitalisation.
Our RH7 registry included 154 patients (15.1%) who were diagnosed with ACLF. The primary cause of the underlying ACLD was alcohol-associated liver disease in the majority (79.8%) of cases. The mean value of LFI at admission was 4.50 (± 0.94). When patients with liver cirrhosis were categorised into three subgroups based on the LFI on day 7, survival exhibited a statistically significant decrease (p≤0.05) across all three ACLF grades. This decline in survival was observed from the 'improved LFI' cohort, through the 'stable LFI' group, to the 'worsened LFI' group.
The impact of day 7 LFI on the survival of patients with ACLF is notable. Nevertheless, it does not markedly enhance the predictive capability of the LFI assessed on admission. Consequently, the initial LFI on day 1 continues to be the most valuable and commonly used instrument for promptly recognising individuals with ACLF.
晚期慢性肝病（ACLD）患者住院与死亡率增加、残疾、生活质量下降及巨大经济成本相关。入院通常表明发生了触发事件，打破了先前的稳定状态，导致ACLD失代偿或出现并发症。这种失衡最急性和严重的表现是慢加急性肝衰竭（ACLF），这是一种代表关键节点的综合征。对ACLF入院患者进行可靠的预后分层有助于系统地提供量身定制的护理，范围从姑息治疗到体外肝支持设备等强化干预措施以及优先肝移植。疾病特异性预后工具，如终末期肝病模型评分，是有效的，但有局限性，特别是在反映患者的恢复潜力方面。在ACLD/ACLF背景下，身体功能储备的概念正受到关注，肝脏脆弱指数（LFI）可能成为推荐的诊断工具。
从我们的肝硬化登记处（RH7）选取患者。LFI作为患者预后的指标。LFI测量在两个时间点进行：患者入院时和住院7天后。
我们的RH7登记处纳入了154例被诊断为ACLF的患者（15.1%）。大多数（79.8%）病例中，潜在ACLD的主要病因是酒精性肝病。入院时LFI的平均值为4.50（±0.94）。当根据第7天的LFI将肝硬化患者分为三个亚组时，在所有三个ACLF等级中，生存率均呈现出统计学上的显著下降（p≤0.05）。从“LFI改善”队列到“LFI稳定”组再到“LFI恶化”组，均观察到生存率下降。
第7天的LFI对ACLF患者生存的影响显著。然而，它并未显著提高入院时评估的LFI的预测能力。因此，第1天的初始LFI仍然是快速识别ACLF患者最有价值且常用的工具。
