Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis

被引:555
作者
Gustot, Thierry [1 ]
Fernandez, Javier [2 ]
Garcia, Elisabet [3 ]
Morando, Filippo [4 ]
Caraceni, Paolo [5 ]
Alessandria, Carlo [6 ]
Laleman, Wim [7 ]
Trebicka, Jonel [8 ]
Elkrief, Laure [9 ]
Hopf, Corinna [10 ]
Solis-Munoz, Pablo [11 ]
Saliba, Faouzi [12 ]
Zeuzem, Stefan [13 ]
Albillos, Augustin [14 ]
Benten, Daniel [15 ]
Montero-Alvarez, Jose Luis [16 ]
Chivas, Maria Teresa [17 ]
Concepcion, Mar [18 ]
Cordoba, Juan [19 ]
McCormick, Aiden [20 ]
Stauber, Rudolf [21 ]
Vogel, Wolfgang [22 ]
de Gottardi, Andrea [23 ]
Welzel, Tania M. [13 ]
Domenicali, Marco [5 ]
Risso, Alessandro [6 ]
Wendon, Julia [11 ]
Deulofeu, Carme [3 ]
Angeli, Paolo [4 ]
Durand, Francois [9 ]
Pavesi, Marco [3 ]
Gerbes, Alexander [10 ]
Jalan, Rajiv [24 ]
Moreau, Richard [9 ]
Gines, Pere [2 ]
Bernardi, Mauro [25 ]
Arroyo, Vicente [25 ]
机构
[1] Univ Libre Bruxelles, Erasme Hosp, Brussels, Belgium
[2] Hosp Clin Barcelona, Barcelona, Spain
[3] CIBEReHD, EASL CLIF Consortium, Data Management Ctr, Barcelona, Spain
[4] Univ Padua, Padua, Italy
[5] Policlin St Orsola Malpighi, Bologna, Italy
[6] Univ Turin, Turin, Italy
[7] Univ Hosp Gasthuisberg, Leuven, Belgium
[8] Univ Hosp Bonn, Bonn, Germany
[9] Hop Beaujon, Clichy, France
[10] Univ Munich, Klinikum LMU, Munich, Germany
[11] Kings Coll Hosp London, London, England
[12] Hop Paul Brousse, Villejuif, France
[13] Univ Frankfurt Hosp, Frankfurt, Germany
[14] Hosp Ramon & Cajal, E-28034 Madrid, Spain
[15] Univ Hosp Hambourg Eppendorf, Hamburg, Germany
[16] Reina Sofia Univ Hosp, Cordoba, Spain
[17] Hosp Gen Gregorio Maranon, Madrid, Spain
[18] Hosp Santa Creu & Sant Pau, E-08025 Barcelona, Spain
[19] Hosp Gen Valle Hebron, Barcelona, Spain
[20] St Vincents Univ Hosp, Dublin 4, Ireland
[21] Med Univ Graz, Graz, Austria
[22] Med Univ Innsbruck, A-6020 Innsbruck, Austria
[23] Univ Bern, Bern, Switzerland
[24] Royal Free Hosp, London NW3 2QG, England
[25] EASL CLIF Consortium, Barcelona, Spain
关键词
SEVERE ALCOHOLIC HEPATITIS; INTENSIVE-CARE; MORTALITY; CIRRHOSIS; SURVIVAL; FUTILITY; TRANSPLANTATION; ALBUMIN; PATIENT; MODEL;
D O I
10.1002/hep.27849
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation (AD) of cirrhosis, organ failure(s), and high 28-day mortality. We investigated whether assessments of patients at specific time points predicted their need for liver transplantation (LT) or the potential futility of their care. We assessed clinical courses of 388 patients who had ACLF at enrollment, from February through September 2011, or during early (28-day) follow-up of the prospective multicenter European Chronic Liver Failure (CLIF) ACLF in Cirrhosis study. We assessed ACLF grades at different time points to define disease resolution, improvement, worsening, or steady or fluctuating course. ACLF resolved or improved in 49.2%, had a steady or fluctuating course in 30.4%, and worsened in 20.4%. The 28-day transplant-free mortality was low-to-moderate (6%-18%) in patients with nonsevere early course (final no ACLF or ACLF-1) and high-to-very high (42%-92%) in those with severe early course (final ACLF-2 or -3) independently of initial grades. Independent predictors of course severity were CLIF Consortium ACLF score (CLIF-C ACLFs) and presence of liver failure (total bilirubin 12 mg/dL) at ACLF diagnosis. Eighty-one percent had their final ACLF grade at 1 week, resulting in accurate prediction of short- (28-day) and mid-term (90-day) mortality by ACLF grade at 3-7 days. Among patients that underwent early LT, 75% survived for at least 1 year. Among patients with 4 organ failures, or CLIF-C ACLFs >64 at days 3-7 days, and did not undergo LT, mortality was 100% by 28 days. Conclusions: Assessment of ACLF patients at 3-7 days of the syndrome provides a tool to define the emergency of LT and a rational basis for intensive care discontinuation owing to futility. (Hepatology 2015;62:243-252)
引用
收藏
页码:243 / 252
页数:10
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