Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF)
Characteristics, risk factors, and mortality of cirrhotic patients hospitalized for hepatic encephalopathy with and without acute-on-chronic liver failure (ACLF)
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DOI：
10.1016/j.jhep.2013.10.004
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发表时间：
2014-02-01
影响因子：
25.7
通讯作者：
Arroyo, Vicente
中科院分区：
文献类型：
--
作者：
Cordoba, Juan;Ventura-Cots, Meritxell;Arroyo, Vicente
背景与目的：尽管肝硬化中肝性脑病（HE）的发病率很高，但观察性研究很少。方法：我们使用 Canonic 研究数据库进行分析，以确定 HE 的特征及相关特征。根据是否存在 HE 和慢加急性肝衰竭 (ACLF) (n = 301)，对 1348 名因急性失代偿而入院的连续肝硬化患者的临床、实验室和生存数据进行比较。结果：HE 的发展与既往 HE 发作独立相关；生存概率随 HE 的存在和程度而恶化。 HE 与 ACLF 相关（n = 174）和不相关（n = 286）之间存在显着差异。与 ACLF 无关的 HE 发生在老年肝硬化患者、不活跃饮酒者中，无严重肝功能衰竭或全身炎症反应，且与利尿剂的使用有关。相比之下，与 ACLF 相关的 HE 发生在年轻的肝硬化患者中，更常见的是酗酒者，伴有严重的肝功能衰竭和全身炎症反应，并且与细菌感染、活动性酗酒和/或稀释性低钠血症有关。第一组的预后相对较好，而第二组的预后则极差。 HE 患者死亡的独立危险因素是年龄、胆红素、INR、肌酐、钠和 HE 分级。结论：在肝硬化中，既往 HE 确定了一个特别容易发生新 HE 发作的患者亚组。根据 ACLF 的存在情况，HE 的病程似乎有所不同。 (C) 2013 年欧洲肝脏研究协会。由 Elsevier B.V. 出版。保留所有权利。
Background & Aims: In spite of the high incidence of hepatic encephalopathy (HE) in cirrhosis, there are few observational studies.Methods: We performed an analysis to define the characteristics of HE and associated features using the database of the Canonic Study. Clinical, laboratory and survival data of 1348 consecutive cirrhotic patients admitted with an acute decompensation were compared according to the presence (n = 406) or absence of HE and of acute-on-chronic liver failure (ACLF) (n = 301).Results: HE development was independently associated with previous HE episodes; survival probabilities worsen in relation to the presence and grade of HE. There were marked differences between HE associated (n = 174) and not associated (n = 286) to ACLF. HE not associated with ACLF occurred in older cirrhotics, inactive drinkers, without severe liver failure or systemic inflammatory reaction and in relation to diuretic use. In contrast, HE associated with ACLF occurred in younger cirrhotics, more frequently alcoholics, with severe liver failure and systemic inflammatory reaction, and in relation to bacterial infections, active alcoholism and/or dilutional hyponatremia. Prognosis was relatively preserved in the first and extremely poor in the second group. Independent risk factors of mortality in patients with HE were age, bilirubin, INR, creatinine, sodium, and HE grade.Conclusions: In cirrhosis, previous HE identifies a subgroup of patients that is especially vulnerable for developing new episodes of HE. The course of HE appears to be different according to the presence of ACLF. (C) 2013 European Association for the Study of the Liver. Published by Elsevier B.V. All rights reserved.