Comparison of the sequential organ failure assessment score with the King's College Hospital criteria and the model for end-stage liver disease score for the prognosis of acetaminophen-induced acute liver failure
Comparison of the sequential organ failure assessment score with the King's College Hospital criteria and the model for end-stage liver disease score for the prognosis of acetaminophen-induced acute liver failure
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DOI：
10.1002/lt.23370
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发表时间：
2012-04-01
影响因子：
4.6
通讯作者：
Burroughs, Andrew K.
中科院分区：
文献类型：
--
作者：
Cholongitas, Evangelos;Theocharidou, Eleni;Burroughs, Andrew K.
对乙酰氨基酚引起的急性肝功能衰竭（ALF）是一种复杂的多器官疾病。对预后的评估对于准确识别不进行肝移植（LT）生存的患者至关重要。本研究的目的是比较预后模型[国王学院医院（KCH），终末期肝病模型，序贯器官衰竭评估（SOFA）和急性生理学和慢性健康评估II（APACHE II）]和识别结果的独立预后指标。我们对连续入住重症监护室的对乙酰氨基酚诱导的严重ALF患者进行了评估。入院时，记录人口统计学、临床和实验室参数。用受试者工作特征曲线下面积（AUC）评价基线时各预后评分的区分能力。此外，使用多元逻辑回归，我们评估了与结果相关的独立因素。总共评价了125例连续的对乙酰氨基酚诱导的ALF患者：67例患者（54%）在保守治疗下存活（第1组），58例患者（46%）在未接受LT（28%）或接受LT（18%;第2组）的情况下死亡。第1组患者的中位APACHE II评分（10比14）和SOFA评分（9比12）显著低于第2组患者（P < 0.001）。与死亡或LT相关的独立指标为凝血酶原时间延长（P = 0.007）、吸入氧浓度（P = 0.005）和12小时乳酸水平（P < 0.001）。KCH标准的特异性最高（83%），但敏感性最低（47%），SOFA评分的区分能力最好（AUC = 0.79）。总之，对于对乙酰氨基酚诱导的ALF患者，SOFA评分的表现优于其他预后评分，这反映了多器官功能障碍的存在。进一步评估SOFA与KCH标准是必要的。肝移植18：405412，2012。(C)2011年AASLD。
Acetaminophen-induced acute liver failure (ALF) is a complex multiorgan illness. An assessment of the prognosis is essential for the accurate identification of patients for whom survival without liver transplantation (LT) is unlikely. The aims of this study were the comparison of prognostic models [King's College Hospital (KCH), Model for End-Stage Liver Disease, Sequential Organ Failure Assessment (SOFA), and Acute Physiology and Chronic Health Evaluation II (APACHE II)] and the identification of independent prognostic indicators of outcome. We evaluated consecutive patients with severe acetaminophen-induced ALF who were admitted to the intensive care unit. At admission, demographic, clinical, and laboratory parameters were recorded. The discriminative ability of each prognostic score at the baseline was evaluated with the area under the receiver operating characteristic curve (AUC). In addition, using a multiple logistic regression, we assessed independent factors associated with outcome. In all, 125 consecutive patients with acetaminophen-induced ALF were evaluated: 67 patients (54%) survived with conservative medical management (group 1), and 58 patients (46%) either died without LT (28%) or underwent LT (18%; group 2). Group 1 patients had significantly lower median APACHE II (10 versus 14) and SOFA scores (9 versus 12) than group 2 patients (P < 0.001). The independent indicators associated with death or LT were a longer prothrombin time (P = 0.007), the inspiratory oxygen concentration (P = 0.005), and the lactate level at 12 hours (P < 0.001). The KCH criteria had the highest specificity (83%) but the lowest sensitivity (47%), and the SOFA score had the best discriminative ability (AUC = 0.79). In conclusion, for patients with acetaminophen-induced ALF, the SOFA score performed better than the other prognostic scores, and this reflected the presence of multiorgan dysfunction. A further evaluation of SOFA with the KCH criteria is warranted. Liver Transpl 18:405412, 2012. (C) 2011 AASLD.