The Use of NACSELD and EASL-CLIF Classification Systems of ACLF in the Prediction of Prognosis in Hospitalized Patients With Cirrhosis
The Use of NACSELD and EASL-CLIF Classification Systems of ACLF in the Prediction of Prognosis in Hospitalized Patients With Cirrhosis
复制标题
使用 NACSELD 和 EASL-CLIF ACLF 分类系统预测住院肝硬化患者的预后。
DOI：
10.14309/ajg.0000000000000771
复制
发表时间：
2020-12-01
影响因子：
9.8
通讯作者：
Xie, Qing
中科院分区：
文献类型：
--
作者：
Cao, Zhujun;Liu, Yuhan;Xie, Qing
介绍
慢性加急性肝功能衰竭（ACLF）是由欧洲肝脏慢性肝功能衰竭研究协会（EASL-CLIF）联盟和北美终末期肝病研究联盟（NACSELD）定义为肝硬化急性恶化，伴有多器官衰竭和高短期死亡率。但是，他们的诊断标准不同。我们的目的是比较这两个标准在预测住院肝硬化的预后。
方法
这是一项在2016年至2018年期间来自一家三级医院的非选择性住院肝硬化患者（N = 468）中进行的前瞻性研究。收集基线特征、发生率和器官衰竭类型以及7、28和90天时的生存数据。比较两种标准的预后效用。
结果
468例患者中有137例（29.3%）患有EASL-CLIF ACLF，468例患者中有35例（7.4%）患有NACSELD ACLF。ACLF的28天无移植存活率使用EASL-CLIF为58.4%，使用NACSELD标准为37.1%。在预测28天死亡率方面，NACSELD标准显示出显著更高的总体准确性（92.0%vs85.3%，P < 0.01），特异性（99.7%vs84.0%，P < 0.001），阳性预测值敏感性（49.3% vs 92.5%，P <0.001）和阴性预测值（91.6% vs 98.5%，P <0.001）均低于EASL-CLIF。结果在预测7天结局方面相似。然而，由于NACSELD ACLF标准的敏感性和阴性预测值降低，NACSELD和EASL-CLIF ACLF标准预测90天死亡率的总体准确性变得相似（86.3% vs 88.7%，P = 0.27）。这2个ACLF标准的预后表现是相似的，当应用于有或无肝炎B病毒感染作为肝硬化的病因的患者。
讨论
NACSELD和EASL-CLIF ACLF标准在肝硬化患者预后预测中既有注意事项，也有实用价值。NACSED标准在预测死亡率方面高度准确，而EASL-CLIF标准在识别肝移植受益患者方面更敏感。
INTRODUCTION
Acute-on-chronic liver failure (ACLF) is defined by the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) consortium and the North American Consortium for the Study of End-Stage Liver Disease (NACSELD) as an acute deterioration of cirrhosis with multiple organ failures and high short-term mortality. However, their diagnostic criteria differ. We aimed to compare these 2 criteria in the prediction of prognosis in hospitalized cirrhosis.
METHODS
This was a prospective study of nonelectively hospitalized patients with cirrhosis (N = 468) from a single tertiary hospital between 2016 and 2018. Baseline characteristics, incidence, and types of organ failure and survival data at 7, 28, and 90 days were collected. Prognostic utilities of the 2 criteria were compared.
RESULTS
One hundred thirty-seven of 468 patients (29.3%) had EASL-CLIF ACLF, and 35 of 468 (7.4%) had NACSELD ACLF. The 28-day transplant-free survival of ACLF was 58.4% using EASL-CLIF and 37.1% using the NACSELD criteria. In predicting 28-day mortality, the NACSELD criteria demonstrated significantly higher overall accuracy (92.0% vs 85.3%, P < 0.01), specificity (99.7% vs 84.0%, P < 0.001), and positive predictive value (97.1% vs 50.4%, P < 0.001) but lower sensitivity (49.3% vs 92.5%, P < 0.001) and negative predictive value (91.6% vs 98.5%, P < 0.001) than those of EASL-CLIF. The results were similar in predicting 7-day outcome. However, the overall accuracy became similar between NACSELD and EASL-CLIF ACLF criteria in predicting 90-day mortality (86.3% vs 88.7%, P = 0.27) because of the decrease of sensitivity and negative predictive value of NACSELD ACLF criteria. The prognostic performance of these 2 ACLF criteria was similar when applied to patients with or without hepatitis B virus infection as an etiology of cirrhosis.
DISCUSSION
There are both caveats and utilities of NACSELD and EASL-CLIF ACLF criteria in prognosis prediction in patients with cirrhosis. NACSED criteria is highly accurate in predicting morality, whereas the EASL-CLIF criteria is more sensitive to identify patients who would benefit from liver transplantation.