Increased delayed mortality in patients with acute-on-chronic liver failure who have prior decompensation
Increased delayed mortality in patients with acute-on-chronic liver failure who have prior decompensation
复制标题
DOI：
10.1111/jgh.12787
复制
发表时间：
2015-04-01
影响因子：
4.1
通讯作者：
Yan, Huadong
中科院分区：
文献类型：
--
作者：
Shi, Yu;Zheng, Ming-hua;Yan, Huadong
慢性加急性肝功能衰竭（ACLF）患者是一个复杂的人群，预后不同。该研究的目的是分类ACLF根据潜在的慢性肝病的严重程度。MethodsA共招募了540例ACLF患者，包括127与先前失代偿性肝硬化和413没有先前失代偿（PD），包括193与潜在的慢性肝炎和220与先前代偿性肝硬化。比较各组的临床特点及预后。考克斯比例风险模型和多项Logistic回归分析，以确定显着的预后parameters.Results28天，3个月和1年的生存ACLF患者与PD或无分别为58.9%比61.4%，36.2%比52.5%，29.1%比49.6%，分别。在多项logistic回归分析或考克斯比例风险模型的死亡时间分析中，PD与28天后死亡率显著相关，但与28天内死亡率无关。在多变量死亡时间分析中，年龄较大、国际标准化比值（INR）和血清胆红素较高、血清钠和血小板计数水平较低、存在肝性脑病（HE）、上消化道出血和呼吸或循环功能障碍是非PD患者28天内死亡的预测因素，而PD患者的风险因素为INR、肌酐较高、存在HE、结论ACLF伴或不伴PD患者的短期预后相似，但1年死亡率不同。有PD的ACLF患者与无PD的ACLF患者在年龄、急性损伤类型、肝损害严重程度和并发症分布方面存在差异，前者的特点是延迟死亡率增加。
Background and AimPatients with acute-on-chronic liver failure (ACLF) represent a complex population with differential prognosis. The aim of the study was to categorize ACLF according to the severity of underlying chronic liver diseases.MethodsA total of 540 ACLF patients were recruited, including 127 with prior decompensated cirrhosis and 413 without prior decompensation (PD) including 193 with underlying chronic hepatitis and 220 with prior compensated cirrhosis. The clinical characteristics and prognosis of subgroups were compared. Cox proportional hazard model and multinominal logistic regression analysis were performed to identify significant prognostic parameters.ResultsThe 28-day, 3-month and 1-year survival of ACLF patients with or without PD were 58.9% versus 61.4%, 36.2 versus 52.5%, and 29.1% versus 49.6%, respectively. On multinominal logistic regression analysis or time-to-death analysis by Cox proportional hazard model, PD was significantly associated with post-28-day mortality but not within-28-day mortality. On multivariate time-to-death analysis, older age, high international normalized ratio (INR) and serum bilirubin, low levels of serum sodium and platelet count, and presence of hepatic encephalopathy (HE), upper gastrointestinal bleeding, and respiratory or circulation dysfunction were predictors of within-28-day mortality in patients without PD, whereas the risk factors in patients with PD were high INR, creatinine, presence of HE, and respiratory or circulation dysfunction.ConclusionACLF patients with or without PD had comparable short-term prognosis but differential 1-year mortality. ACLF patients with PD were distinct from those without PD in age, types of acute insults, severity of hepatic damage, and distribution of complications, and the former group was characterized by increased delayed mortality.