Clinical Course of acute-on-chronic liver failure syndrome and effects on prognosis
Por:
Gustot, T, Fernandez, J, Garcia, E, Morando, F, Caraceni, P, Alessandria, C, Laleman, W, Trebicka, J, Elkrief, L, Hopf, C, Solis-Munoz, P, Saliba, F, Zeuzem, S, Albillos, A, Benten, D, Montero-Alvarez, JL, Chivas, MT, Concepcion, M, Cordoba, J, McCormick, A, Stauber, R, Vogel, W, de Gottardi, A, Welzel, TM, Domenicali, M, Risso, A, Wendon, J, Deulofeu, C, Angeli, P, Durand, F, Pavesi, M, Gerbes, A, Jalan, R, Moreau, R, Gines, P, Bernardi, M, Arroyo, V
Publicada:
1 jul 2015
Resumen:
Acute-on-chronic liver failure (ACLF) is characterized by acute decompensation (AD) of cirrhosis, organ failure(s), and high 28-day mortality. We investigated whether assessments of patients at specific time points predicted their need for liver transplantation (LT) or the potential futility of their care. We assessed clinical courses of 388 patients who had ACLF at enrollment, from February through September 2011, or during early (28-day) follow-up of the prospective multicenter European Chronic Liver Failure (CLIF) ACLF in Cirrhosis study. We assessed ACLF grades at different time points to define disease resolution, improvement, worsening, or steady or fluctuating course. ACLF resolved or improved in 49.2%, had a steady or fluctuating course in 30.4%, and worsened in 20.4%. The 28-day transplant-free mortality was low-to-moderate (6%-18%) in patients with nonsevere early course (final no ACLF or ACLF-1) and high-to-very high (42%-92%) in those with severe early course (final ACLF-2 or -3) independently of initial grades. Independent predictors of course severity were CLIF Consortium ACLF score (CLIF-C ACLFs) and presence of liver failure (total bilirubin 12 mg/dL) at ACLF diagnosis. Eighty-one percent had their final ACLF grade at 1 week, resulting in accurate prediction of short- (28-day) and mid-term (90-day) mortality by ACLF grade at 3-7 days. Among patients that underwent early LT, 75% survived for at least 1 year. Among patients with 4 organ failures, or CLIF-C ACLFs >64 at days 3-7 days, and did not undergo LT, mortality was 100% by 28 days. Conclusions: Assessment of ACLF patients at 3-7 days of the syndrome provides a tool to define the emergency of LT and a rational basis for intensive care discontinuation owing to futility. (Hepatology 2015;62:243-252)
Filiaciones:
Gustot, T:
Univ Libre Bruxelles, Erasme Hosp, Brussels, Belgium
Fernandez, J:
Hosp Clin Barcelona, Barcelona, Spain
Garcia, E:
CIBEReHD, EASL CLIF Consortium, Data Management Ctr, Barcelona, Spain
Morando, F:
Univ Padua, Padua, Italy
Caraceni, P:
Policlin St Orsola Malpighi, Bologna, Italy
Alessandria, C:
Univ Turin, Turin, Italy
Laleman, W:
Univ Hosp Gasthuisberg, Leuven, Belgium
Trebicka, J:
Univ Hosp Bonn, Bonn, Germany
Elkrief, L:
Hop Beaujon, Clichy, France
Hopf, C:
Univ Munich, Klinikum LMU, Munich, Germany
Solis-Munoz, P:
Kings Coll Hosp London, London, England
Saliba, F:
Hop Paul Brousse, Villejuif, France
Zeuzem, S:
Univ Frankfurt Hosp, Frankfurt, Germany
Albillos, A:
Hosp Ramon & Cajal, E-28034 Madrid, Spain
Benten, D:
Univ Hosp Hambourg Eppendorf, Hamburg, Germany
Montero-Alvarez, JL:
Reina Sofia Univ Hosp, Cordoba, Spain
Chivas, MT:
Hosp Gen Gregorio Maranon, Madrid, Spain
Concepcion, M:
Hosp Santa Creu & Sant Pau, E-08025 Barcelona, Spain
Cordoba, J:
Hosp Gen Valle Hebron, Barcelona, Spain
McCormick, A:
St Vincents Univ Hosp, Dublin 4, Ireland
Stauber, R:
Med Univ Graz, Graz, Austria
Vogel, W:
Med Univ Innsbruck, A-6020 Innsbruck, Austria
de Gottardi, A:
Univ Bern, Bern, Switzerland
Welzel, TM:
Univ Frankfurt Hosp, Frankfurt, Germany
Domenicali, M:
Policlin St Orsola Malpighi, Bologna, Italy
Risso, A:
Univ Turin, Turin, Italy
Wendon, J:
Kings Coll Hosp London, London, England
Deulofeu, C:
CIBEReHD, EASL CLIF Consortium, Data Management Ctr, Barcelona, Spain
Angeli, P:
Univ Padua, Padua, Italy
Durand, F:
Hop Beaujon, Clichy, France
Pavesi, M:
CIBEReHD, EASL CLIF Consortium, Data Management Ctr, Barcelona, Spain
Gerbes, A:
Univ Munich, Klinikum LMU, Munich, Germany
Jalan, R:
Royal Free Hosp, London NW3 2QG, England
Moreau, R:
Hop Beaujon, Clichy, France
Gines, P:
Hosp Clin Barcelona, Barcelona, Spain
Bernardi, M:
EASL CLIF Consortium, Barcelona, Spain
Arroyo, V:
EASL CLIF Consortium, Barcelona, Spain
Bronze, Green Published
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