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New Algorithm Rules Out Acute-on-chronic Liver Failure Development within 28 Days from Acute Decompensation of Cirrhosis

查看全文 作　　者：Xiaoting [1]Tang;Hai [2,3]Li;Guohong [4]Deng;Xin [5]Zheng;Xianbo [6]Wang;Yan [7]Huang;Yanhang [8]Gao;Zhongji [9]Meng;Zhiping [10]Qian;Feng [11]Liu;Xiaobo [12]Lu;Yu [13,14,15]Shi;Beiling [1]Li;Wenyi [2,3]Gu;Xiaomei [4]Xiang;Yan [5]Xiong;Yixin [6]Hou;Jun [7]Chen;Na [8]Gao;Sen [9]Luo;Liujuan [10]Ji;Jing [11]Li;Rongjiong [12]Zheng;Haotang [13,14,15]Ren;Jinjun [1,16]Chen 高影响力作者 机构地区：[1]Hepatology Unit,Department of Infectious Diseases,Nanfang Hospital,Southern Medical University,Guangzhou,Guangdong,China;[2]Department of Gastroenterology,Ren Ji Hospital,School of Medicine,Shanghai Jiao Tong University,Shang-hai,China;[3]Shanghai Institute of Digestive Disease,Key Laboratory of Gastroenterology and Hepatology,Chinese Ministry of Health(Shanghai Jiao Tong University),Shanghai,China;[4]Department of Infectious Diseases,Southwest Hospital,Third Military Medical University(Army Medical University),Chongqing,China;[5]Department of Infectious Diseases,Institute of Infection and Immunology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,Hubei,China;[6]Center of Integrative Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing,China;[7]Department of Infectious Diseases,Hunan Key Laboratory of Viral Hepatitis,Xiangya Hospital,Central South University,Changsha,Hunan,China;[8]Department of Hepatology,The First Hospital of Jilin University,Changchun,Jilin,China;[9]Department of Infectious Diseases,Hubei Clinical Research Center for Precise Diagnosis and Treatment of Liver Cancer,Taihe Hospital,Hubei University of Medicine,Shiyan,Hubei,China;[10]Department of Liver Intensive Care Unit,Shanghai Public Health Clinical Center,Fudan University,Shanghai,China;[11]Department of Infectious Diseases and Hepatology,The Second Hospital of Shandong Univer-sity,Jinan,Shandong,China;[12]Infectious Disease Center,The First Affiliated Hospital of Xinjiang Medical University,Xinjiang,China;[13]The State Key Laboratory for Diagnosis and Treatment of Infectious Diseases,The First Affiliated Hospital of School of Medicine,Zhejiang University,Hangzhou,Zhejiang,China;[14]Collaborative Innovation Center for Diagnosis and Treatment of Infectious Disease,Hangzhou,Zhejiang,China;[15]National Clinical Research Center of Infectious Disease,Hangzhou,Zhejiang,China;[16]Hepatology Unit,Zengcheng Branch,Nanfang Hospital,Southern Medical University,Guangzhou,Guangdong,China.高影响力机构 出　　处：《Journal of Clinical and Translational Hepatology》索引2023年第11卷第3期,共10页高影响力期刊 基　　金：the National Science and Technology Major Project(2018ZX10723203,2018ZX10302206);National Natural Science Foundation of China(82070650,81270533,81470038);National Key Research and Development Program of China(2017YFC0908100);Local Innova-tive and Research Teams Project of Guangdong Pearl River Talents Program(2017BT01S131);Key Scientific and Technological Program of Guangzhou City(201508020262);Department of Science and Technology of Guangdong Province(2014B020228003,2015B020226004);Clinical Research Program of Nanfang Hospital,Southern Medical University(2018CR037,2020CR026);Key-Area Research and Development Program of Guangdong Province(2019B020227004);Clinical Research Startup Program of Southern Medical University by High-level University Construction Funding of Guangdong Provincial Department of Education(LC2019ZD006,LC2016PY005);President Foundation of Nanfang Hospital,Southern Medical University(2019Z003). 摘　　要：Background and Aims:Approximately 10%of patients with acute decompensated(AD)cirrhosis develop acute-on-chronic liver failure(ACLF)within 28 days.Such cases have high mortality and are difficult to predict.Therefore,we aimed to establish and validate an algorithm to identify these patients on hospitalization.Methods:Hospitalized patients with AD who developed ACLF within 28 days were considered pre-ACLF.Organ dysfunction was defined accord-ing to the chronic liver failure-sequential organ failure as-sessment(CLIF-SOFA)criteria,and proven bacterial infec-tion was taken to indicate immune system dysfunction.A retrospective multicenter cohort and prospective one were used to derive and to validate the potential algorithm,re-spectively.A miss rate of<5%was acceptable for the calcu-lating algorithm to rule out pre-ACLF.Results:In the deri-vation cohort(n=673),46 patients developed ACLF within 28 days.Serum total bilirubin,creatinine,international normalized ratio,and present proven bacterial infection at admission were associated with the development of ACLF.AD patients with≥2 organ dysfunctions had a higher risk for pre-ACLF patients[odds ratio=16.58195%confidence interval:(4.271-64.363),p<0.001].In the derivation co-hort,67.5%of patients(454/673)had≤1 organ dysfunction and two patients(0.4%)were pre-ACLF,with a miss rate of 4.3%(missed/total,2/46).In the validation cohort,65.9%of patients(914/1388)had≤1 organ dysfunction,and four(0.3%)of them were pre-ACLF,with a miss rate of 3.4%(missed/total,4/117).Conclusions:AD patients with≤1 organ dysfunction had a significantly lower risk of developing ACLF within 28 days of admission and could be safely ruled out with a pre-ACLF miss rate of<5%. 关 键 词：Liver cirrhosis Prognosis Liver failure End-stage liver disease Organ dysfunction scores.
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