Characteristics and Discrepancies in Acute-on-Chronic Liver Failure: Need for a Unified Definition

被引：53

作者：

Kim, Tae Yeob ^{[1
]}

Song, Do Seon ^{[2
]}

Kim, Hee Yeon ^{[2
]}

Sinn, Dong Hyun ^{[3
]}

Yoon, Eileen L. ^{[4
]}

Kim, Chang Wook ^{[2
]}

Jung, Young Kul ^{[5
]}

Suk, Ki Tae ^{[6
]}

Lee, Sang Soo ^{[7
]}

Lee, Chang Hyeong ^{[8
]}

Kim, Tae Hun ^{[9
]}

Kim, Jeong Han ^{[10
]}

Choe, Won Hyeok ^{[10
]}

Yim, Hyung Joon ^{[5
]}

Kim, Sung Eun ^{[11
]}

Baik, Soon Koo ^{[12
]}

Lee, Byung Seok ^{[13
]}

Jang, Jae Young ^{[14
]}

Suh, Jeong Ill ^{[15
]}

Kim, Hyoung Su ^{[16
]}

Nam, Seong Woo ^{[17
]}

Kwon, Hyeok Choon ^{[17
]}

Kim, Young Seok ^{[18
]}

Kim, Sang Gyune ^{[18
]}

Chae, Hee Bok ^{[19
,20
]}

Yang, Jin Mo ^{[2
]}

Sohn, Joo Hyun ^{[21
]}

Lee, Heon Ju ^{[22
]}

Park, Seung Ha ^{[23
]}

Han, Byung Hoon ^{[24
]}

Choi, Eun Hee ^{[25
]}

Kim, Chang H. ^{[26
]}

Kim, Dong Joon ^{[6
]}

机构：

[1] Hanyang Univ, Inst Med Sci, Seoul 133791, South Korea

[2] Catholic Univ Korea, Dept Internal Med, Coll Med, Seoul, South Korea

[3] Sungkyunkwan Univ, Sch Med, Samsung Med Ctr, Dept Internal Med, Seoul, South Korea

[4] Inje Univ, Dept Internal Med, Sanggye Paik Hosp, Seoul, South Korea

[5] Korea Univ, Dept Internal Med, Ansan Hosp, Ansan, South Korea

[6] Hallym Univ, Dept Internal Med, Coll Med, Chunchon, South Korea

[7] Gyeongsang Natl Univ Hosp, Dept Internal Med, Jinju, South Korea

[8] Catholic Univ, Dept Internal Med, Daegu Sch Med, Daegu, South Korea

[9] Ewha Womans Univ, Dept Internal Med, Sch Med, Seoul, South Korea

[10] Konkuk Univ, Dept Internal Med, Sch Med, Seoul, South Korea

[11] Hallym Univ, Sacred Heart Hosp, Dept Internal Med, Anyang, South Korea

[12] Yonsei Univ, Dept Internal Med, Wonju Coll Med, Wonju, South Korea

[13] Chungnam Natl Univ, Sch Med, Dept Internal Med, Daejeon, South Korea

[14] Soonchunhyang Univ, Dept Internal Med, Coll Med, Seoul, South Korea

[15] Dongguk Univ, Dept Internal Med, Gyeongju Hosp, Gyeongju, South Korea

[16] Hallym Univ, Dept Internal Med, Kangdong Sacred Heart Hosp, Seoul, South Korea

[17] Natl Med Ctr, Dept Internal Med, Seoul, South Korea

[18] Soonchunhyang Univ, Dept Internal Med, Bucheon Hosp, Bucheon, South Korea

[19] Chungbuk Natl Univ, Dept Internal Med, Coll Med, Cheongju, South Korea

[20] Chungbuk Natl Univ, Med Res Inst, Cheongju, South Korea

[21] Hanyang Univ, Dept Internal Med, Guri Hosp, Guri, South Korea

[22] Yeungnam Univ, Dept Internal Med, Coll Med, Daegu, South Korea

[23] Inje Univ, Dept Internal Med, Haeundae Paik Hosp, Coll Med, Busan, South Korea

[24] Kosin Univ, Coll Med, Dept Internal Med, Busan, South Korea

[25] Yonsei Univ, Wonju Coll Med, Inst Lifestyle Med, Wonju, South Korea

[26] Univ Hosp Case Med Ctr, Dept Internal Med, Cleveland, OH USA

来源：

PLOS ONE | 2016年 / 11卷 / 01期

关键词：

ASIAN-PACIFIC ASSOCIATION; ORGAN FAILURE; CONSENSUS RECOMMENDATIONS; ACUTE DECOMPENSATION; CIRRHOTIC-PATIENTS; MORTALITY; VALIDATION; DISTINCT; DISEASE; SYSTEM;

D O I：

10.1371/journal.pone.0146745

中图分类号：

O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];

学科分类号：

07 ; 0710 ; 09 ;

摘要：

Background & Aim To investigate the prevalence, mortalities, and patient characteristics of Acute-on-chronic liver failure (ACLF) according to the AARC (Asian Pacific Association for the Study of the Liver ACLF Research Consortium) and European Association for the Study of the Liver CLIF-C (Chronic Liver Failure Consortium) definitions. Methods We collected retrospective data for 1470 hospitalized patients with chronic liver disease (CLD) and acute deterioration between January 2013 and December 2013 from 21 university hospitals in Korea. Results Of the patients assessed, the prevalence of ACLF based on the AARC and CLIF-C definitions was 9.5% and 18.6%, respectively. The 28-day and 90-day mortality rates were higher in patients with ACLF than in those without ACLF. Patients who only met the CLIF-C definition had significantly lower 28-day and 90-day survival rates than those who only met the AARC definition (68.0% vs. 93.9%, P<0.001; 55.1% vs. 92.4%, P<0.001). Among the patients who had non-cirrhotic CLD, the 90-day mortality of the patients with ACLF was higher than of those without ACLF, although not significant (33.3% vs. 6.0%, P = 0.192). Patients with previous acute decompensation (AD) within 1-year had a lower 90-day survival rate than those with AD more than 1 year prior or without previous AD (81.0% vs. 91.9% or 89.4%, respectively, all P<0.001). Patients who had extra-hepatic organ failure without liver failure had a similar 90-day survival rate to those who had liver failure as a prerequisite (57.0% vs. 60.6%, P = 0.391). Conclusions The two ACLF definitions result in differences in mortality and patient characteristics among ACLF patients. We suggest that non-cirrhotic CLD, previous AD within 1 year, and extrahepatic organ failure should be included in the ACLF diagnostic criteria. In addition, further studies are necessary to develop a universal definition of ACLF.

引用

页数：18

共 28 条

[1] Simple organ failure count versus CANONIC grading system for predicting mortality in acute-on-chronic liver failure [J].