Outcomes in Adults With Acute Liver Failure Between 1998 and 2013: An Observational Cohort Study.
Outcomes in Adults With Acute Liver Failure Between 1998 and 2013: An Observational Cohort Study.
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DOI：
10.7326/m15-2211
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发表时间：
2016-06-07
影响因子：
39.2
通讯作者：
Lee WM
中科院分区：
文献类型：
--
作者：
Reuben A;Tillman H;Fontana RJ;Davern T;McGuire B;Stravitz RT;Durkalski V;Larson AM;Liou I;Fix O;Schilsky M;McCashland T;Hay JE;Murray N;Shaikh OS;Ganger D;Zaman A;Han SB;Chung RT;Smith A;Brown R;Crippin J;Harrison ME;Koch D;Munoz S;Reddy KR;Rossaro L;Satyanarayana R;Hassanein T;Hanje AJ;Olson J;Subramanian R;Karvellas C;Hameed B;Sherker AH;Robuck P;Lee WM
急性肝衰竭（ALF）是一种罕见的严重、快速发作的肝功能障碍综合征，既往无晚期肝病，发病率和死亡率较高。重症监护和肝移植分别提供支持和抢救。确定近年来在美国三级医疗中心转诊的成人ALF患者中，病因、疾病严重程度、治疗或21天结局是否发生变化。前瞻性观察性队列研究。（ClinicalTrials.gov：NCT 00518440）美国31家肝病和移植中心。连续入组ALF患者-既往无晚期肝病-（n = 2070）。每年对临床特征、治疗和21天结局进行趋势比较，并将其分为两个8年期（1998 - 2005年和2006 - 2013年）。在整个研究期间，总体临床特征、疾病严重程度和病因分布保持相似。两个8年期之间的21天生存率增加（总体，67.1% vs. 75.3%;无移植存活率[TFS]，45.1% vs. 56.2%;移植后存活率，88.3% vs. 96.3% [各P < 0.010]）。红细胞输注减少（44.3% vs 27.6%），血浆输注（65.2% vs. 47.1%），机械通气（65.7% vs. 56.1%）和血管加压药（34.9%对27.8%），以及N-乙酰半胱氨酸的使用增加（总体48.9% vs. 69.3%;非对乙酰氨基酚毒性所致ALF患者中15.8% vs. 49.4% [P < 0.001]）。当纵向检查时，总生存率和TFS在整个16年期间增加。参与研究中心的入组持续时间、入组患者数量以及可能的治疗方法各不相同。结果可能无法推广到这些专门中心之外。虽然ALF的特征和严重程度在16年内变化不大，但总生存率和TFS显著改善。重症监护实践中的具体变化对生存的影响值得进一步研究。美国国立卫生研究院。
Acute liver failure (ALF) is a rare syndrome of severe, rapid-onset hepatic dysfunction without prior advanced liver disease that is associated with high morbidity and mortality. Intensive care and liver transplantation provide support and rescue, respectively. To determine whether changes in causes, disease severity, treatment, or 21-day outcomes have occurred in recent years among adult patients with ALF referred to U.S. tertiary care centers. Prospective observational cohort study. (ClinicalTrials.gov: NCT00518440) 31 liver disease and transplant centers in the United States. Consecutively enrolled patients–without prior advanced liver disease–with ALF (n = 2070). Clinical features, treatment, and 21-day outcomes were compared over time annually for trends and were also stratified into two 8-year periods (1998 to 2005 and 2006 to 2013). Overall clinical characteristics, disease severity, and distribution of causes remained similar throughout the study period. The 21-day survival rates increased between the two 8-year periods (overall, 67.1% vs. 75.3%; transplant-free survival [TFS], 45.1% vs. 56.2%; posttransplantation survival, 88.3% vs. 96.3% [P < 0.010 for each]). Reductions in red blood cell infusions (44.3% vs. 27.6%), plasma infusions (65.2% vs. 47.1%), mechanical ventilation (65.7% vs. 56.1%), and vasopressors (34.9% vs. 27.8%) were observed, as well as increased use of N-acetylcysteine (48.9% vs. 69.3% overall; 15.8% vs. 49.4% [P < 0.001] in patients with ALF not due to acetaminophen toxicity). When examined longitudinally, overall survival and TFS increased throughout the 16-year period. The duration of enrollment, the number of patients enrolled, and possibly the approaches to care varied among participating sites. The results may not be generalizable beyond such specialized centers. Although characteristics and severity of ALF changed little over 16 years, overall survival and TFS improved significantly. The effects of specific changes in intensive care practice on survival warrant further study. National Institutes of Health.