急性慢性肝功能衰竭的患病率和短期死亡率：来自美国的一

StephenW

Prevalence and short-term mortality of acute-on-chronic liver failure: A national cohort study from the USA
Ruben Hernaez1,2,3,low asterisk,'Correspondence information about the author Ruben Hernaez†,Email the author Ruben Hernaez
, Jennifer R. Kramer1,2,3,†
, Yan Liu1,2,3
, Aylin Tansel4
, Yamini Natarajan1,3
, Khozema B. Hussain1,3
, Pere Ginès5,6,7,8
, Elsa Solà5,6,7,8
, Richard Moreau8,9,10,11
, Alexander Gerbes12
, Hashem B. El-Serag1,2,3
, Fasiha Kanwal1,2,3
PlumX Metrics
DOI: https://doi.org/10.1016/j.jhep.2018.12.018 |

Highlights

    •Of 72,316 ethnically diverse patients from 127 Veterans Affairs facilities in the US, 19,082 (26.39%) met ACLF criteria.
    •Patients with ACLF had high 28- and 90-day mortality (25.52% and 40.02%, respectively).
    •Mortality risk increased in parallel with the number of OFs, ranging from 17–53% at 28 days and 31–69% at 90 days.
    •African-American race and being seen at a transplant centre were associated with a lower risk of ACLF mortality.

Background & Aims

Acute-on-chronic liver failure (ACLF) is characterised by the presence of organ failure in patients with decompensated cirrhosis and is associated with high short-term mortality. However, there are limited data on the prevalence and short-term outcomes of ACLF in patients with cirrhosis seen in the US. We aimed to study the prevalence and risk factors associated with the development and short term mortality in a large cohort of patients in the US.
Methods

Using the US Department of Veterans Affairs (VA) Corporate Data Warehouse, we identified patients with ACLF during hospitalisation for decompensated cirrhosis at any of the 127 VA hospitals between January 1, 2004, and December 31, 2014. We examined the prevalence of ACLF and variables associated with 28- and 90-day mortality in ACLF, and trends in prevalence and survival over time.
Results

Of 72,316 patients hospitalised for decompensated cirrhosis, 19,082 (26.4%) patients met the criteria of ACLF on admission. Of these, 12.8% had 1, 10.1% had 2, and 3.5% had 3 or more organ failures. Overall, 25.5% and 40.0% of ACLF patients died within 28 days and 90 days of admission, respectively. Older age, White race, liver cancer, higher model for end-stage liver disease sodium corrected score, and non-liver transplant centre were associated with increased risk of death in ACLF. Over the study period, the prevalence of ACLF decreased, and all grades but ACLF-3 had improvement in survival.
Conclusions

In a US cohort of hospitalised patients with decompensated cirrhosis, ACLF was common and associated with high short-term mortality. Over a decade, ACLF prevalence decreased but survival improvement of ACLF-3 was not seen. Early recognition and aggressive management including timely referral to transplant centres may lead to improved outcomes in ACLF.
Lay summary

Acute-on-chronic liver failure (ACLF) is a condition marked by multiple organ failures in patients with cirrhosis and associated with a high risk of death. In this study of US patients hospitalised with cirrhosis, 1 in 4 patients developed ACLF. In total, 25% of patients with ACLF died within 1 month and 40% died within 3 months. Thus, early recognition of ACLF is important for the initiation of aggressive management, which is required to save these patients’ lives.
Keywords:
Cirrhosis, Natural history, Prognosis, Research outcomes, Transplant centre

StephenW

急性慢性肝功能衰竭的患病率和短期死亡率：来自美国的一项全国性队列研究
Ruben Hernaez1,2,3，低星号，'关于作者Ruben Hernaez的通讯信息†，发送电子邮件给作者Ruben Hernaez
，Jennifer R. Kramer1,2,3，†
，刘艳1,2,3
，Aylin Tansel4
，Yamini Natarajan1,3
，Khozema B. Hussain1,3
，PereGinès5,6,7,8
，ElsaSolà5,6,7,8
，Richard Moreau8,9,10,11
，Alexander Gerbes12
，Hashem B. El-Serag1,2,3
，Fasiha Kanwal1,2,3
PlumX度量标准
DOI：https：//doi.org/10.1016/j.jhep.2018.12.018 |

强调

    •来自美国127个退伍军人事务部门的72,316名不同种族的患者中，有19,082名（26.39％）符合ACLF标准。
    •ACLF患者的28天和90天死亡率较高（分别为25.52％和40.02％）。
    •死亡风险与OFs数量同时增加，28天为17-53％，90天为31-69％。
    •非裔美国人种族和在移植中心被发现与ACLF死亡风险较低有关。

背景与目的

急性慢性肝功能衰竭（ACLF）的特征是失代偿期肝硬化患者存在器官衰竭，并伴有高短期死亡率。然而，关于美国肝硬化患者ACLF患病率和短期预后的数据有限。我们的目的是研究与美国一大批患者的发展和短期死亡率相关的患病率和风险因素。
方法

使用美国退伍军人事务部（VA）公司数据仓库，我们在2004年1月1日至2014年12月31日期间在127家弗吉尼亚州医院的任何一家医院确诊患有失代偿期肝硬化的患者。我们检查了ACLF的患病率和与ACLF中28天和90天死亡率相关的变量，以及随着时间的推移流行率和存活率的趋势。
结果

在因失代偿性肝硬化住院的72,316例患者中，19,082例（26.4％）患者入院时符合ACLF标准。其中，12.8％有1％，10.1％有2，3.5％有3个或更多器官衰竭。总体而言，25.5％和40.0％的ACLF患者分别在入院后28天和90天内死亡。年龄较大，白种人，肝癌，终末期肝病钠校正评分和非肝移植中心的较高模型与ACLF死亡风险增加有关。在研究期间，ACLF的患病率下降，除ACLF-3外，所有等级的生存率均有所提高。
结论

在美国队列失代偿期肝硬化住院患者中，ACLF很常见且与短期死亡率高有关。十多年来，ACLF患病率下降，但未见ACLF-3的生存改善。早期识别和积极管理，包括及时转诊到移植中心，可能会改善ACLF的预后。
放置摘要

急性慢性肝功能衰竭（ACLF）是一种以肝硬化患者多器官功能衰竭为特征的病症，并且具有高死亡风险。在这项对肝硬化住院的美国患者的研究中，四分之一的患者发生了ACLF。总共有25％的ACLF患者在1个月内死亡，40％在3个月内死亡。因此，早期识别ACLF对于开始积极管理非常重要，这是挽救这些患者生命所必需的。
关键词：
肝硬化，自然史，预后，研究成果，移植中心