中文English
ISSN 1001-5256 (Print)
ISSN 2097-3497 (Online)
CN 22-1108/R
Volume 39 Issue 10
Oct.  2023
Turn off MathJax
Article Contents

Acute-on-chronic liver failure: Features and prognosis of a new clinical classification system based on onset manifestations

DOI: 10.3969/j.issn.1001-5256.2023.10.015
Research funding:

Construction Project of High-level Technology Talents in Public Health (Discipline leader-01-12);

Beijing Hospitals Authority’s Ascent Plan (DFL20221501);

Beijing Nova Program (20220484201);

Beijing Natural Science Foundation (7232081)

More Information
  • Corresponding author: CHEN Yu, chybeyond1071@ccmu.edu.cn (ORCID: 0000-0001-7612-3240)
  • Received Date: 2023-06-26
  • Published Date: 2023-10-30
  •   Objective  To investigate the characteristics of intrahepatic and extrahepatic organ failure at the onset of acute-on-chronic liver failure(ACLF), to explore the features of a new clinical classification system of ACLF, and to provide a basis for the diagnosis, treatment, prognostic analysis of the disease.  Methods  A retrospective analysis was performed for the clinical data of the patients who were hospitalized Beijing YouAn Hospital, Capital Medical University, from January 2015 to October 2022 and were diagnosed with ACLF for the first time. According to the conditions of intrahepatic and extrahepatic organ failure at disease onset, they were classified into type Ⅰ ACLF and type Ⅱ ACLF. Type Ⅰ ACLF referred to liver failure on the basis of chronic liver diseases, and type Ⅱ ACLF referred to acute decompensation of chronic liver diseases combined with multiple organ failure. The clinical features of patients with type Ⅰ or type Ⅱ ACLF were analyzed, and the receiver operating characteristic (ROC) curve was used to assess the value of MELD, MELD-Na, and CLIF-C ACLF scoring system in predicting the 90-day prognosis of ACLF patients with type Ⅰ or type Ⅱ ACLF. The independent-samples t test was used for comparison of normally distributed continuous data between two groups, and the Wilcoxon rank-sum test was used for comparison of non-normally distributed continuous data between two groups; the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups.  Results  A total of 582 patients with ACLF were enrolled, among whom there were 535 patients with type Ⅰ ACLF and 47 patients with type Ⅱ ACLF. Hepatitis B and alcoholic liver disease were the main causes in both groups, with no significant difference between the two groups (P>0.05). Chronic non-cirrhotic liver disease (28.2%) and compensated liver cirrhosis (56.8%) were the main underlying liver diseases in type Ⅰ ACLF, while compensated liver cirrhosis (34.0%) and decompensated liver cirrhosis (61.7%) were the main underlying liver diseases in type Ⅱ ACLF, and there was no significant difference in underlying liver diseases between the patients with type Ⅰ ACLF and those with type Ⅱ ACLF (P<0.001). The patients with type Ⅱ ACLF had significantly higher median MELD score, MELD-Na score, and CLIF-C ACLF score than those with type Ⅰ ACLF (all P<0.001). The patients with type Ⅱ ACLF had significantly higher 28- and 90-day mortality rates than those with type Ⅰ ACLF (38.3%/53.2% vs 15.5%/27.5%, P<0.001). For the patients with type Ⅰ ACLF who did not progress to multiple organ failure, the patients with an increase in MELD score accounted for 63.7% in the death group and 10.1% in the survival group (P<0.001), while for the patients with type Ⅰ ACLF who progressed to multiple organ failure, there was no significant difference in the change in MELD score between the survival group and the death group (P>0.05). In the patients with type Ⅰ ACLF, MELD score, MELD-Na score, and CLIF-C ACLF score had an area under the ROC curve (AUC) of 0.735, 0.737, and 0.740, respectively, with no significant difference between any two scores (all P>0.05). In the patients with type Ⅱ ACLF, CLIF-C ACLF score had a significantly higher AUC than MELD score (0.880 vs 0.560, P<0.01) and MELD-Na score (0.880 vs 0.513, P<0.01).  Conclusion  There are differences in underlying liver diseases, clinical features, and prognosis between type Ⅰ and type Ⅱ ACLF, and different prognosis scoring systems have different emphases, which provide a basis for the new clinical classification system of ACLF from the perspective of evidence-based medicine.

     

  • loading
  • [1]
    Liver Failure and Artificial Liver Group, Chinese Society of Infectious Diseases, Chinese Medical Association; Severe Liver Disease and Artificial Liver Group, Chinese Society of Hepatology, Chinese Medical Association. Guideline for diagnosis and treatment of liver failure(2018)[J]. J Clin Hepatol, 2019, 35( 1): 38- 44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.

    中华医学会感染病学分会肝衰竭与人工肝学组, 中华医学会肝病学分会重型肝病与人工肝学组. 肝衰竭诊治指南(2018年版)[J]. 临床肝胆病杂志, 2019, 35( 1): 38- 44. DOI: 10.3969/j.issn.1001-5256.2019.01.007.
    [2]
    ZHANG YZ, CHEN Y. Heterogeneity of definition, clinical characteristics, treatment and prognosis of acute liver failure with chronic exacerbation[J]. Chin Hepatol, 2021, 26( 10): 1072- 1074. DOI: 10.14000/j.cnki.issn.1008-1704.2021.10.003.

    张译之, 陈煜. 慢加急性肝衰竭定义、临床特征、治疗与预后的异质性探讨[J]. 肝脏, 2021, 26( 10): 1072- 1074. DOI: 10.14000/j.cnki.issn.1008-1704.2021.10.003.
    [3]
    BI ZH, WANG LX, LIAN JQ. Definition, prognostic assessment, and advances in the diagnosis and treatment of acute-on-chronic liver failure[J]. J Clin Hepatol, 2022, 38( 7): 1671- 1676. DOI: 10.3969/j.issn.1001-5256.2022.07.041.

    毕占虎, 王临旭, 连建奇. 慢加急性肝衰竭的定义、预后评估及诊治进展[J]. 临床肝胆病杂志, 2022, 38( 7): 1671- 1676. DOI: 10.3969/j.issn.1001-5256.2022.07.041.
    [4]
    SARIN SK, CHOUDHURY A, SHARMA MK, et al. Acute-on-chronic liver failure: Consensus recommendations of the Asian Pacific association for the study of the liver(APASL): An update[J]. Hepatol Int, 2019, 13( 4): 353- 390. DOI: 10.1007/s12072-019-09946-3.
    [5]
    MOREAU R, JALAN R, GINES P, et al. Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis[J]. Gastroenterology, 2013, 144( 7): 1426- 1437.e 9. DOI: 10.1053/j.gastro.2013.02.042.
    [6]
    O’LEARY JG, REDDY KR, GARCIA-TSAO G, et al. NACSELD acute-on-chronic liver failure(NACSELD-ACLF) score predicts 30-day survival in hospitalized patients with cirrhosis[J]. Hepatology, 2018, 67( 6): 2367- 2374. DOI: 10.1002/hep.29773.
    [7]
    XU MM, YU PF, CHEN Y, et al. Amencan college of gas⁃troenterology clinical guidelines for acute-on-chromc liver failure[J]. Chin J Hepatol, 2022, 30( 2): 199- 203. DOI: 10.3760/cma.j.cn501113-20220126-00047.

    徐曼曼, 余朋飞, 陈煜, 等. 美国胃肠病学会《慢加急性肝衰竭临床指南》摘译[J]. 中华肝脏病杂志, 2022, 30( 2): 199- 203. DOI: 10.3760/cma. j. cn501113-20220126-00047.
    [8]
    BAJAJ JS, O’LEARY JG, LAI JC, et al. Acute-on-chronic liver failure clinical guidelines[J]. Am J Gastroenterol, 2022, 117( 2): 225- 252. DOI: 10.14309/ajg.0000000000001595.
    [9]
    MEZZANO G, JUANOLA A, CARDENAS A, et al. Global burden of disease: Acute-on-chronic liver failure, a systematic review and meta-analysis[J]. Gut, 2022, 71( 1): 148- 155. DOI: 10.1136/gutjnl-2020-322161.
    [10]
    MALINCHOC M, KAMATH PS, GORDON FD, et al. A model to predict poor survival in patients undergoing transjugular intrahepatic portosystemic shunts[J]. Hepatology, 2000, 31( 4): 864- 871. DOI: 10.1053/he.2000.5852.
    [11]
    BIGGINS SW, KIM WR, TERRAULT NA, et al. Evidence-based incorporation of serum sodium concentration into MELD[J]. Gastroenterology, 2006, 130( 6): 1652- 1660. DOI: 10.1053/j.gastro.2006.02.010.
    [12]
    JALAN R, SALIBA F, PAVESI M, et al. Development and validation of a prognostic score to predict mortality in patients with acute-on-chronic liver failure[J]. J Hepatol, 2014, 61( 5): 1038- 1047. DOI: 10.1016/j.jhep.2014.06.012.
    [13]
    HERNAEZ R, LIU Y, KRAMER JR, et al. Model for end-stage liver disease-sodium underestimates 90-day mortality risk in patients with acute-on-chronic liver failure[J]. J Hepatol, 2020, 73( 6): 1425- 1433. DOI: 10.1016/j.jhep.2020.06.005.
    [14]
    BAROSA R, ROQUE RAMOS L, PATITA M, et al. CLIF-C ACLF score is a better mortality predictor than MELD, MELD-Na and CTP in patients with acute on chronic liver failure admitted to the ward[J]. Rev Esp Enferm Dig, 2017, 109( 6): 399- 405. DOI: 10.17235/reed.2017.4701/2016.
    [15]
    ABDALLAH MA, KUO YF, ASRANI S, et al. Validating a novel score based on interaction between ACLF grade and MELD score to predict waitlist mortality[J]. J Hepatol, 2021, 74( 6): 1355- 1361. DOI: 10.1016/j.jhep.2020.12.003.
    [16]
    LI N, HUANG C, YU KK, et al. Validation of prognostic scores to predict short-term mortality in patients with HBV-related acute-on-chronic liver failure: The CLIF-C OF is superior to MELD, CLIF SOFA, and CLIF-C ACLF[J]. Medicine, 2017, 96( 17): e6802. DOI: 10.1097/MD.0000000000006802.
  • 加载中

Catalog

    通讯作者: 陈斌, bchen63@163.com
    • 1. 

      沈阳化工大学材料科学与工程学院 沈阳 110142

    1. 本站搜索
    2. 百度学术搜索
    3. 万方数据库搜索
    4. CNKI搜索

    Figures(4)  / Tables(2)

    Article Metrics

    Article views (201) PDF downloads(45) Cited by()
    Proportional views
    Related

    /

    DownLoad:  Full-Size Img  PowerPoint
    Return
    Return