The Prediction of In‐Hospital Mortality in Decompensated Cirrhosis with Acute‐on‐Chronic Liver Failure

医学 肝硬化 急性失代偿性心力衰竭 内科学 肝移植 肝衰竭 重症监护医学 胃肠病学 移植 心力衰竭
作者
Florence Wong,K. Rajender Reddy,Puneeta Tandon,Jennifer C. Lai,Nishita Jagarlamudi,Vanessa Weir,Beverley Kok,Sylvia Kalainy,Yanin Srisengfa,Somaya Albhaisi,Bradley Reuter,Chathur Acharya,Jawaid Shaw,Leroy R. Thacker,Jasmohan S. Bajaj
出处
期刊:Liver Transplantation [Lippincott Williams & Wilkins]
卷期号:28 (4): 560-570 被引量:13
标识
DOI:10.1002/lt.26311
摘要

Acute-on-chronic liver failure (ACLF) is a condition in cirrhosis associated with organ failure (OF) and high short-term mortality. Both the European Association for the Study of the Liver-Chronic Liver Failure (EASL-CLIF) and North American Consortium for the Study of End-Stage Liver Disease (NACSELD) ACLF definitions have been shown to predict ACLF prognosis. The aim of this study was to compare the ability of the EASL-CLIF versus NACSELD systems over baseline clinical and laboratory parameters in the prediction of in-hospital mortality in admitted patients with decompensated cirrhosis. Five NACSELD centers prospectively collected data to calculate EASL-CLIF and NACSELD-ACLF scores for admitted patients with cirrhosis who were followed for the development of OF, hospital course, and survival. Both the number of OFs and the ACLF grade or presence were used to determine the impact of NACSELD versus EASL-CLIF definitions of ACLF above baseline parameters on in-hospital mortality. A total of 1031 patients with decompensated cirrhosis (age, 57 ± 11 years; male, 66%; Child-Pugh-Turcotte score, 10 ± 2; Model for End-Stage Liver Disease [MELD] score, 20 ± 8) were enrolled. Renal failure prevalence (28% versus 9%, P < 0.001) was more common using the EASL-CLIF versus NACSELD definition, but the prevalence rates for brain, circulatory, and respiratory failures were similar. Baseline parameters including age, white cell count on admission, and MELD score reasonably predicted in-hospital mortality (area under the curve, 0.76). The addition of number of OFs according to either system did not improve the predictive power of the baseline parameters for in-hospital mortality, but the presence of NACSELD-ACLF did. However, neither system was better than baseline parameters in the prediction of 30- or 90-day outcomes. The presence of NACSELD-ACLF is equally effective as the EASL-CLIF ACLF grade, and better than baseline parameters in the prediction of in-hospital mortality in patients with cirrhosis, but not superior in the prediction of longer-term 30- or 90-day outcomes.
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