Zhang Qian, Hu Jiaxuan, Qiu Shaotian, Bian Jiale, Gao Aimin, Liu Fang, Zhao Caiyan, Zhang Liaoyun, Ren Wanhua, Xin Shaojie, Chen Yu, Duan Zhongping, Han Tao
Department of Gastroenterology and Hepatology, Tianjin Union Medical Center, The First Affiliated Hospital of Nankai University, 190 Jieyuan Road, Hongqiao District, Tianjin, 300121, China.
Tianjin Medical University, Tianjin, 300070, China.
Sci Rep. 2025 Jul 13;15(1):25292. doi: 10.1038/s41598-025-09620-9.
Acute-on-chronic liver failure (ACLF) exhibits etiological heterogeneity across regions, with hepatitis B virus (HBV)-related ACLF predominant in China and alcohol-related ACLF dominating Western populations. This multicenter retrospective study systematically compared clinical profiles of HBV-related (n = 659) and alcohol-related ACLF (n = 296) stratified by the World Gastroenterology Organization (WGO) A/B/C classification, reflecting underlying chronic liver disease severity. Compared to HBV-related ACLF, alcohol-related ACLF showed higher systemic inflammation (leukocytosis, neutrophilia), bacterial infection (P < 0.001), extrahepatic organ failures (single-organ: renal, brain and respiratory, all P < 0.05; multi-organ: P < 0.001) and higher CLIF-C ACLF/COSSH-ACLF II scores. Conversely, HBV-related ACLF exhibited acute hepatocellular injury (elevated ALT/AST), and higher MELD/MELD-Na scores. These etiological disparities were most pronounced in type C ACLF. Despite these distinct profiles, mortality did not differ between etiologies. Type C ACLF demonstrated poorest profiles and uniformly high 90-day mortality (> 45%) regardless of etiology driven by cumulative organ failure burden. Importantly, CLIF-C ACLF and COSSH-ACLF II scores outperformed MELD and MELD-Na scores in predicting outcomes for type C patients. These findings underscore the critical influence of diverse etiologies and severity stages of underlying chronic liver diseases on ACLF profiles and outcomes, thereby necessitating stratified management approaches tailored to underlying chronic liver disease to ultimately improve patient outcomes.
慢加急性肝衰竭（ACLF）在不同地区存在病因异质性，在中国以乙型肝炎病毒（HBV）相关的ACLF为主，而在西方人群中酒精相关的ACLF占主导。这项多中心回顾性研究系统比较了按世界胃肠病学组织（WGO）A/B/C分类分层的HBV相关（n = 659）和酒精相关ACLF（n = 296）的临床特征，以反映潜在慢性肝病的严重程度。与HBV相关的ACLF相比，酒精相关的ACLF表现出更高的全身炎症（白细胞增多、中性粒细胞增多）、细菌感染（P < 0.001）、肝外器官衰竭（单器官：肾脏、脑和呼吸，均P < 0.05；多器官：P < 0.001）以及更高的CLIF-C ACLF/COSSH-ACLF II评分。相反，HBV相关的ACLF表现出急性肝细胞损伤（ALT/AST升高）以及更高的MELD/MELD-Na评分。这些病因差异在C型ACLF中最为明显。尽管有这些不同的特征，但不同病因的死亡率并无差异。C型ACLF表现出最差的特征，无论病因如何，90天死亡率均统一较高（> 45%），这是由累积器官衰竭负担所致。重要的是，在预测C型患者的预后方面，CLIF-C ACLF和COSSH-ACLF II评分优于MELD和MELD-Na评分。这些发现强调了潜在慢性肝病的不同病因和严重程度阶段对ACLF特征和预后的关键影响，因此需要针对潜在慢性肝病制定分层管理方法，以最终改善患者预后。
