NACSELD acute-on-chronic liver failure (NACSELD-ACLF) score predicts 30-day survival in hospitalized patients with cirrhosis
NACSELD acute-on-chronic liver failure (NACSELD-ACLF) score predicts 30-day survival in hospitalized patients with cirrhosis
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DOI：
10.1002/hep.29773
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发表时间：
2018-06-01
期刊：
影响因子：
13.5
通讯作者：
Bajaj, Jasmohan S.
中科院分区：
文献类型：
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作者：
O'Leary, Jacqueline G.;Reddy, K. Rajender;Bajaj, Jasmohan S.
北美终末期肝病研究联盟将急性慢性肝衰竭（NACSELD-ACLF）定义为两个或两个以上肝外器官衰竭，已被提议作为评估住院肝硬化患者死亡风险的简单床边工具。我们在一个单独的多中心前瞻性队列中验证了NACSELD-ACLF预测30天生存率（定义为住院死亡或临终关怀出院）的能力，该队列包括感染和未感染的住院肝硬化患者。我们使用了14个三级肝病中心的NACSELD数据库，前瞻性地纳入了非选择性肝硬化住院患者（n = 2675）。该队列随机分为60%/40%训练组（n = 1,605）和测试组（n = 1,070）。器官衰竭评估为(1)休克，(2)肝性脑病（III/IV级），(3)肾脏（需要透析）和(4)呼吸（机械通气）。患者最常见的是白人（79%）男性（62%），平均年龄为57岁，诊断为酒精性肝硬化（45%），1,079例患者在住院期间发生感染。终末期肝病模型平均评分为19分，Child评分中位数为10分。两组之间没有人口统计学上的差异。多变量模型显示，在控制入院年龄、白细胞计数、血清白蛋白、终末期肝病模型评分和感染后，由器官衰竭数量决定的NACSELD-ACLF评分是降低生存率的最强预测因子。训练集的c统计量为0.8073，验证集的c统计量为0.8532。结论：尽管感染状态仍然是死亡的重要预测因素，但NACSELD-ACLF在一个独立的大型跨国前瞻性队列中被独立验证，作为预测诊断为肝硬化的感染和未感染住院患者30天生存率的简单、可靠的床边工具。(肝脏病学67:2367 2018;2374)。
The North American Consortium for the Study of End-Stage Liver Disease's definition of acute-on-chronic liver failure (NACSELD-ACLF) as two or more extrahepatic organ failures has been proposed as a simple bedside tool to assess the risk of mortality in hospitalized patients with cirrhosis. We validated the NACSELD-ACLF's ability to predict 30-day survival (defined as in-hospital death or hospice discharge) in a separate multicenter prospectively enrolled cohort of both infected and uninfected hospitalized patients with cirrhosis. We used the NACSELD database of 14 tertiary care hepatology centers that prospectively enrolled nonelective hospitalized patients with cirrhosis (n = 2,675). The cohort was randomly split 60%/40% into training (n = 1,605) and testing (n = 1,070) groups. Organ failures assessed were (1) shock, (2) hepatic encephalopathy (grade III/IV), (3) renal (need for dialysis), and (4) respiratory (mechanical ventilation). Patients were most commonly Caucasian (79%) men (62%) with a mean age of 57 years and a diagnosis of alcohol-induced cirrhosis (45%), and 1,079 patients had an infection during hospitalization. The mean Model for End-Stage Liver Disease score was 19, and the median Child score was 10. No demographic differences were present between the two split groups. Multivariable modeling revealed that the NACSELD-ACLF score, as determined by number of organ failures, was the strongest predictor of decreased survival after controlling for admission age, white blood cell count, serum albumin, Model for End-Stage Liver Disease score, and presence of infection. The c-statistics were 0.8073 for the training set and 0.8532 for the validation set. Conclusion: Although infection status remains an important predictor of death, NACSELD-ACLF was independently validated in a separate large multinational prospective cohort as a simple, reliable bedside tool to predict 30-day survival in both infected and uninfected patients hospitalized with a diagnosis of cirrhosis. (Hepatology 2018;67:2367-2374).