Mortality Risk According to Different Clinical Characteristics of First Episode of Liver Decompensation in Cirrhotic Patients: A Nationwide, Prospective, 3-Year Follow-Up Study in Italy
Mortality Risk According to Different Clinical Characteristics of First Episode of Liver Decompensation in Cirrhotic Patients: A Nationwide, Prospective, 3-Year Follow-Up Study in Italy
复制标题
DOI：
10.1038/ajg.2013.110
复制
发表时间：
2013-07-01
影响因子：
9.8
通讯作者：
Almasio, Piero Luigi
中科院分区：
文献类型：
--
作者：
Bruno, Savino;Saibeni, Simone;Almasio, Piero Luigi
目的：失代偿的发生是肝硬化病程中的一个关键转折点。本研究的目的是根据首次失代偿的临床特征评估死亡风险，同时考虑慢加急性肝衰竭（AoCLF）的影响。
方法：我们在意大利进行了一项前瞻性全国起始队列研究。失代偿定义为存在腹水（显性腹水或超声检测到的腹水）、胃食管静脉曲张破裂出血（GEVB）和肝性脑病（HE）。AoCLF根据亚太肝脏研究协会的标准定义。采用多变量Cox比例风险回归分析失败（死亡或原位肝移植（OLT））的风险。
结果：共有490例连续的肝硬化患者（314例男性，平均年龄60.9±12.6岁）符合研究标准。59例患者（12.0%）被确定为AoCLF。在其余431例患者中，330例患者存在腹水（76.6%）：其中257例（77.8%）为显性腹水，73例（22.2%）为超声检测到的腹水。77例患者（17.9%）出现GEVB，30例患者（7.0%）出现HE。中位随访33个月后，24例患者接受了OLT，125例患者死亡。AoCLF患者在1年、2年和3年后失败（死亡或OLT）的累积发生率分别为28%、53%和62%；超声检测到腹水的患者分别为10%、18%和25%；显性腹水患者分别为17%、31%和41%；GEVB患者分别为8%、12%和24%（P<...此处原文未完整给出P值相关内容）
OBJECTIVES: The occurrence of decompensation marks a crucial turning point in the course of cirrhosis. The purpose of this study was to assess the risk of mortality according to the clinical characteristics of first decompensation, considering also the impact of acute-on-chronic liver failure (AoCLF).METHODS: We conducted a prospective nationwide inception cohort study in Italy. Decompensation was defined by the presence of ascites, either overt or detected by ultrasonography (UD), gastroesophageal variceal bleeding (GEVB), and hepatic encephalopathy (HE). AoCLF was defined according to the Asian Pacific Association for the Study of the Liver criteria. Multivariable Cox proportional hazards regression was used to analyze the risk of failure (death or orthotopic liver transplantation (OLT)).RESULTS: A total of 490 consecutive cirrhotic patients (314 males, mean age 60.9 +/- 12.6 years) fulfilled the study criteria. AoCLF was identified in 59 patients (12.0%). Among the remaining 431 patients, ascites were found in 330 patients (76.6%): in 257 (77.8%) as overt ascites and in 73 (22.2%) as UD ascites. GEVB was observed in 77 patients (17.9%) and HE in 30 patients (7.0%). After a median follow-up of 33 months, 24 patients underwent OLT and 125 died. The cumulative incidence of failure (death or OLT) after 1, 2, and 3 years was, respectively, 28, 53, and 62% in patients with AoCLF; 10, 18, and 25% in patients with UD ascites; 17, 31, and 41% in patients with overt ascites; and 8, 12, and 24% in patients with GEVB (P