死亡风险，根据不同的临床特点，肝硬化患者的肝功能失代

StephenW

Liver

Subject Category: Liver

Am J Gastroenterol 2013; 108:1112–1122; doi:10.1038/ajg.2013.110; published online 4 June 2013
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

Savino Bruno MD1, Simone Saibeni MD1, Vincenzo Bagnardi Eng.2,3, Carmen Vandelli MD4, Massimo De Luca MD5, Martina Felder MD6, Anna Ludovica Fracanzani MD7, Cleofe Prisco MD8, Giovanna Vitaliani MD9, Loredana Simone MD10, Giovanni Battista Gaeta MD11, Maria Stanzione MD11, Marcello Persico MD12, Caterina Furlan MD13, Tommaso Stroffolini MD13, Francesco Salerno MD14, Patrick Maisonneuve Eng.2 and Piero Luigi Almasio MD15 on behalf of the AISF (Italian Association for the Study of the Liver)–EPA-SCO Collaborative Study Group16

    1Dipartimento di Medicina Interna, A.O. Fatebenefratelli e Oftalmico, Milano, Italy
    2Divisione di Epidemiologia e Biostatistica, Istituto Europeo di Oncologia, Milano, Italy
    3Dipartimento di Statistica e Metodi Quantitativi, Università of Milano-Bicocca, Milano, Italy
    4Dipartimento di Medicina Interna, Università di Modena e Reggio Emilia, Modena, Italy
    5Unità di Epatologia, Dipartimento di Gastroenterologia, A.O. Cardarelli, Napoli, Italy
    6Unità di Gastroenterologia, Ospedale Centrale, Bolzano, Italy
    7Centro Malattie Metaboliche del Fegato Dipartimento di Fisiopatologia e dei Trapianti, Università di Milano, Fondazione Ca’ Granda IRCCS, Ospedale Policlinico, Milano, Italy
    8Epatologia e Gastroenterologia, Ospedale Niguarda Ca’ Granda, Milano, Italy
    9Unità di Epatologia, Ospedale Predabissi, Melegnano, Italy
    10U.O. di Gastroenterologia ed Endoscopia Digestiva, Azienda Ospedaliera Universitaria Arcispedale S. Anna, Ferrara, Italy
    11Divisione Epatiti Virali acute e croniche, Dipartimento di Medicina Interna e Specialistica, Seconda Università di Napoli, Napoli, Italy
    12Dipartimento di Medicina Interna, Seconda Università di Napoli, Napoli, Italy
    13Dipartimento di Malattie Infettive e Tropicali, Università La Sapienza, Roma, Italy
    14Medicina Interna 1 ed Epatologia, I.R.C.C.S. Policlinico San Donato e Università degli Studi di Milano San Donato Milanese, Milano, Italy
    15U.O.C. di Gastroenterologia e di Epatologia, Di.Bi.M.I.S., Università degli Studi di Palermo, Palermo, Italy

Correspondence: Piero Luigi Almasio, MD, U.O.C. di Gastroenterologia e di Epatologia, Di.Bi.M.I.S., Università degli Studi di Palermo, Piazza delle Cliniche, 2, 90127 Palermo, Italy. E-mail: [email protected]

16See Appendix.

Received 2 October 2012; Accepted 19 March 2013
Advance online publication 4 June 2013
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Abstract
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<0.0001).
CONCLUSIONS:


AoCLF is responsible for a relevant proportion of first decompensation in cirrhotic patients and is associated with the poorest outcome. Patients with UD ascites do not have a negligible mortality rate and require clinical monitoring similar to that of patients with overt ascites.

StephenW

失代偿的发生，标志着肝硬化的过程中，一个关键的转折点。这项研究的目的是评估死亡率的风险，根据首先失代偿的临床特点，也考虑急性慢性肝衰竭（AoCLF）的影响。
方法：


我们在意大利以来全国进行了一项前瞻性队列研究。被定义失代偿腹水，无论是公开或超声检测（UD），胃食管静脉曲张破裂出血（GEVB），肝性脑病（HE）的存在。 AoCLF根据亚太肝脏标准研究协会定义。多变量Cox比例风险回归来分析失败的风险（死亡或原位肝移植（OLT））。
结果：


连续490例肝硬化患者（男314人，平均年龄60.9±12.6岁），共完成了研究标准。 AoCLF确定59例（12.0％）。在余下的431名患者中，330例（76.6％）：257（77.8％），明显的腹水和73（22.2％），UD腹水腹水。 GEVB观察77例（17.9％），他在30例（7.0％）。中位随访33个月后，24例患者接受OLT和125人死亡。分别累计发生故障（死亡或OLT）后1，2，和3年，28，53，和62％在患者AoCLF; 10，18，和25％的在UD腹水患者，17，31 ，41％的患者有明显的腹水，8，12，和24％的患者与GEVB（P <0.0001）。
结论：


AoCLF负责相关先失代偿肝硬化患者的比例，是与最贫穷的结果。 UD腹水患者不具有可以忽略不计的死亡率和需要的临床监测病人有明显的腹水。