Survival in infection-related acute-on-chronic liver failure is defined by extrahepatic organ failures.
Survival in infection-related acute-on-chronic liver failure is defined by extrahepatic organ failures.
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DOI：
10.1002/hep.27077
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发表时间：
2014-07
期刊：
影响因子：
13.5
通讯作者：
Kamath, Patrick S.
中科院分区：
文献类型：
--
作者：
Bajaj, Jasmohan S.;O'Leary, Jacqueline G.;Reddy, K. Rajender;Wong, Florence;Biggins, Scott W.;Patton, Heather;Fallon, Michael B.;Garcia-Tsao, Guadalupe;Maliakkal, Benedict;Malik, Raza;Subramanian, Ram M.;Thacker, Leroy R.;Kamath, Patrick S.
感染使肝硬化患者的生存率恶化;然而，需要从多中心研究中获得感染相关慢加急性肝衰竭（I-ACLF）患者生存率的简单预测因子，以改善诊断和资源分配。使用NACSELD数据库，收集了来自18个中心的数据，对前瞻性入组的因感染住院的肝硬化患者进行生存分析。我们将器官衰竭定义为（i）休克，（ii）III/IV级肝性脑病（HE），（iii）需要透析（iv）机械通气。分析了这些器官衰竭的生存决定因素。纳入507例患者（55岁，52% HCV，15.8%医院感染，96% Child评分≥ 7），453例患者的30天评价可用。尿路感染（UTI）（28.5%）和自发性细菌性腹膜炎（SBP）（22.5%）最常见。住院期间，55.7%发生HE，17.6%发生休克，15.1%需要肾脏替代，15.8%需要通气; 23%在30天内死亡，21.6%发生二次感染。入院患者发生0例（38.4%）、1例（37.3%）、2例（10.4%）、3例（10%）或4例（4%）器官衰竭。30-随着肝外器官衰竭数量的增加，生存天数恶化，无（92%）、1（72.6%）、2（51.3%）、3（36%）和所有4（23%）例。考虑到该临界值时相关生存概率的显著变化，I-ACLF定义为≥ 2个器官衰竭。发生ACLF的基线独立预测因子为院内感染、MELD评分、低平均动脉压（MAP）和非SBP感染。30天生存率差的独立预测因子为I-ACLF、二次感染、入院时高MELD、低MAP、高白色血细胞计数和低白蛋白。总之，使用多中心研究数据，在住院失代偿感染性胰腺炎患者，I-ACLF定义的存在两个或两个以上的器官衰竭，使用简单的定义是预测生存率差。
Infections worsen survival in cirrhosis; however, simple predictors of survival in infection-related acute-on-chronic liver failure (I-ACLF) derived from multi-center studies are required in order to improve prognostication and resource allocation. Using the NACSELD database, data from 18 centers were collected for survival analysis of prospectively enrolled cirrhotic patients hospitalized with an infection. We defined organ failures as (i) shock, (ii) grade III/IV hepatic encephalopathy(HE), (iii) need for dialysis (iv) mechanical ventilation. Determinants of survival with these organ failures were analyzed. 507 patients were included (55 yrs, 52% HCV, 15.8% nosocomial infection, 96% Child score≥7) and 30-day evaluations were available in 453 patients. Urinary tract infection (UTI) (28.5%), and spontaneous bacterial peritonitis (SBP) (22.5%) were most prevalent. During hospitalization, 55.7% developed HE, 17.6% shock, 15.1% required renal replacement, and 15.8% needed ventilation; 23% died within 30-days and 21.6% developed second infections. Admitted patients developed none (38.4%), one (37.3%), two (10.4%), three (10%) or four (4%) organ failures. 30-day survival worsened with higher number of extra-hepatic organ failures, none (92%), one (72.6%), two (51.3%), three (36%) and all four (23%). I-ACLF was defined as ≥2 organ failures given the significant change in survival probability associated at this cutoff. Baseline independent predictors for development of ACLF were nosocomial infections, MELD score, low mean arterial pressure (MAP), and non-SBP infections. Independent predictors of poor 30-day survival were I-ACLF, second infections, and admission values of high MELD, low MAP, high white blood count and low albumin. In conclusion, using multi-center study data in hospitalized decompensated infected cirrhotic patients, I-ACLF defined by the presence of two or more organ failures using simple definitions is predictive of poor survival.
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影响因子：
24.5
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通讯作者：
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