Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014
Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014
复制标题
DOI：
10.1007/s12072-014-9580-2
复制
发表时间：
2014-10-01
影响因子：
6.6
通讯作者：
Yokosuka, Osamu
中科院分区：
文献类型：
--
作者：
Sarin, Shiv Kumar;Kedarisetty, Chandan Kumar;Yokosuka, Osamu
亚太肝脏研究协会 (APASL) 于 2004 年成立，工作组关于慢加急性肝衰竭 (ACLF) 的第一份共识报告于 2009 年发表。由于知识和现有信息的快速发展，亚太各国成员组成的联盟“APASL ACLF 研究联盟 AARC”于 2012 年成立。在此数据库中进行整理和跟踪。当前的 ACLF 定义是根据新的 AARC 数据库重新评估的。这些举措于 2014 年 2 月在新德里举行的为期两天的会议上得出结论，并促成了 AARC 最终共识的制定。只有那些基于证据并得到一致推荐的陈述才会被接受。这些声明再次分发给所有专家，并随后在2014年3月14日于布里斯班举行的APASL年会上提交。专家组对代表们的建议进行了分析，并对共识进行了修改。最终的共识和指导方针文件已准备就绪。经过详细的审议和数据分析，最初提出的定义经受住了时间的考验，并确定了一组出现肝衰竭的同质患者。根据 AARC 数据、肝衰竭分级及其对“黄金治疗窗口”、肝外器官衰竭和脓毒症发展的影响进行了分析。提出了新的治疗方案，包括凝血障碍的治疗方案、肾脏替代治疗、败血症、静脉曲张出血、抗病毒药物以及 ACLF 患者肝移植的标准。最终共识声明以及相关背景信息如下。
The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver APASL) set up in 2004 on acute-on-chronic liver failure ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, "APASL ACLF Research Consortium AARC)," was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the original proposed definition was found to withstand the test of time and identify a homogenous group of patients presenting with liver failure. Based on the AARC data, liver failure grading, and its impact on the "Golden therapeutic Window," extra-hepatic organ failure and development of sepsis were analyzed. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals, and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information are presented here.