因急性失代偿期肝硬化和脏器衰竭住院的患者有发生ACLF和迅速死亡的风险。却没有ACLF的诊断标准，对它的进展知之甚少。目的是制定ACLF的诊断标准并描述这种综合征在欧洲AD患者中的发展。收集2011年2月-9月来自欧洲29个肝病中心的1343名住院患者。用器官衰竭和死亡率数据来定义ACLF的分级，进而评估ACLF与AD死亡率的差异。通过分析患者器官衰竭(CLIF-SOFA)和高28天死亡率（>15%）来制定ACLF的诊断标准。在评估的患者中，研究开始时有303名患者患有ACLF，112名发展为ACLF，928名没有ACLF。ACLF患者组28天死亡率为33.9%，进展为ACLF患者组28天死亡率是29.7%，而没有ACLF患者组28天死亡率是1.9%。ACLF患者与没有ACLF的患者相比，具有年轻，频繁饮酒，较高相关细菌感染，高白细胞计数，及高血浆C-反应蛋白等特点（P < .001）。高CLIF-SOFA 评分和白细胞计数是ACLF患者死亡率的独立预测因素。有病史的AD患者与无病史AD患者相比，ACLF意外的具有高器官衰竭，高白细胞计数，和高死亡率这些特点。通过分析急性失代偿期肝硬化患者数据来制定ACLF诊断标准表明：ACLF不同于AD,它不仅基于器官衰竭、高死亡率，还与年龄、突发事件。全身炎症反应有关。ACLF死亡率与器官衰竭、高白细胞计数相关联。没有病史的AD患者发生ACLF后果尤其严重。
吉林大学第一医院肝病科 姜红丽 摘译
本文首次发表于[Gastroenterology, 2013,144(7):1426-1437]
Acute-on-Chronic Liver Failure Is a Distinct Syndrome That Develops in Patients With Acute Decompensation ofCirrhosis.
Abstract
BACKGROUND & AIMS:
Patients with cirrhosis hospitalized for an acute decompensation (AD) and organ failure are at risk for imminent death and considered to have acute-on-chronic liver failure (ACLF). However, there are no established diagnostic criteria for ACLF, so little is known about its development and progression. We aimed to identify diagnostic criteria of ACLF and describe the development of this syndrome in European patientswith AD.
METHODS:
We collected data from 1343 hospitalized patients with cirrhosis and AD from February to September 2011 at 29 liver units in 8 European countries. We used the organ failure and mortality data to define ACLF grades, assess mortality, and identify differences between ACLF and AD. We established diagnostic criteria for ACLF based on analyses of patients with organ failure (defined by the chronic liver failure-sequential organ failureassessment [CLIF-SOFA] score) and high 28-day mortality rate (>15%).
RESULTS:
Of the patients assessed, 303 had ACLF when the study began, 112 developed ACLF, and 928 did not have ACLF. The 28-day mortality rate among patients who had ACLF when the study began was 33.9%, among those who developed ACLF was 29.7%, and among those who did not have ACLF was 1.9%. Patients with ACLF were younger and more frequently alcoholic, had more associated bacterial infections, and had higher numbers of leukocytes and higher plasma levels of C-reactive protein than patients without ACLF (P < .001). Higher CLIF-SOFA scores and leukocyte counts were independent predictors of mortality in patients with ACLF. In patients without a prior history of AD, ACLF was unexpectedly characterized by higher numbers of organ failures, leukocyte count, and mortality compared with ACLF in patients with a prior history of AD.
CONCLUSIONS:
We analyzed data from patients with cirrhosis and AD to establish diagnostic criteria for ACLF and showed that it is distinct from AD, based not only on the presence of organ failure(s) and high mortality rate but also on age, precipitating events, and systemic inflammation. ACLF mortality is associated with loss of organ function and high leukocyte counts. ACLF is especially severe in patients with no prior history of AD.
