Incidence, predictors and outcomes of acute-on-chronic liver failure in outpatients with cirrhosis
Incidence, predictors and outcomes of acute-on-chronic liver failure in outpatients with cirrhosis
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DOI：
10.1016/j.jhep.2017.07.008
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发表时间：
2017-12-01
影响因子：
25.7
通讯作者：
Angeli, Paolo
中科院分区：
文献类型：
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作者：
Piano, Salvatore;Tonon, Marta;Angeli, Paolo
背景与目的：慢性加急性肝衰竭（ACLF）是肝硬化最严重的并发症。ACLF的患病率和结果最近已在肝硬化住院患者中进行了描述。然而，目前尚无关于门诊肝硬化患者ACLF的患病率和危险因素的数据。本研究的目的是评估发病率，预测因素和ACLF的结果在一个大的队列的门诊患者肝硬化。方法：共466例肝硬化患者连续评估的门诊三级医院包括和随访，直到死亡和/或肝移植平均45 +/- 44个月。在此期间，收集了肝和肝外器官衰竭发生的数据。ACLF的定义和分级根据EASL-CLIF Consortium definition.Results：在随访期间，118例（25%）发生ACLF：57级-1，33级-2，28级-3。1年、5年和10年时发生ACLF的概率分别为14%、29%和41%。在多变量分析中，基线平均动脉压（风险比[HR] 0.96; p = 0.012）、腹水（HR 2.53; p = 0.019）、终末期肝病模型评分（HR 1.26; p
Background & Aims: Acute-on-chronic liver failure (ACLF) is the most life-threatening complication of cirrhosis. Prevalence and outcomes of ACLF have recently been described in hospitalized patients with cirrhosis. However, no data is currently available on the prevalence and the risk factors of ACLF in outpatients with cirrhosis. The aim of this study was to evaluate incidence, predictors and outcomes of ACLF in a large cohort of outpatients with cirrhosis.Methods: A total of 466 patients with cirrhosis consecutively evaluated in the outpatient clinic of a tertiary hospital were included and followed up until death and/or liver transplantation for a mean of 45 +/- 44 months. Data on development of hepatic and extrahepatic organ failures were collected during this period. ACLF was defined and graded according to the EASL-CLIF Consortium definition.Results: During the follow-up, 118 patients (25%) developed ACLF: 57 grade-1, 33 grade-2 and 28 grade-3. The probability of developing ACLF was 14%, 29%, and 41% at 1 year, 5 years, and 10 years, respectively. In the multivariate analysis, baseline mean arterial pressure (hazard ratio [HR] 0.96; p = 0.012), ascites (HR 2.53; p = 0.019), model of end-stage liver disease score (HR 1.26; p