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Abstract：
BACKGROUND: Acute-on-chronic liver failure (ACLF) is a common syndrome that occurs in patients with advanced chronic liver disease. It consists of the rapid failure of various organs and is associated with high short-term mortality. We aim to describe the main features and outcomes of inpatients who developed ACLF and to identify the factors associated with in-hospital and 28-day mortality.
METHODS: All patients meeting ACLF criteria with advanced chronic liver disease admitted for decompensation from January 2014 to December 2016 were identified. Clinical and biological data were collected at the time of ACLF diagnosis and at 3-7 days thereafter, as well as in-hospital and 28-day mortality.
RESULTS: Eighty nine out of 354 admission episodes (28%) developed ACLF, which was present at the time of admission in 72% of cases. A precipitating factor was identified in 83% of cases, the most frequent being infection (53%) and gastrointestinal bleeding (19%). In the multivariate regression analysis, the ACLF grade at 3-7 days after diagnosis was predictive of in-hospital mortality and 28-day mortality, and lower creatinine and bilirubin levels at the time of ACLF diagnosis and a precipitating factor other than bacterial infection were associated with ACLF reversion at 3-7 days.
CONCLUSIONS: ACLF is a frequent complication among patients with chronic liver disease admitted for acute decompensations and is associated with a high mortality rate and is related to the number of organs involved. Bacterial infection is the most frequent precipitating factor of ACLF and probably entails a worse prognosis.
METHODS: All patients meeting ACLF criteria with advanced chronic liver disease admitted for decompensation from January 2014 to December 2016 were identified. Clinical and biological data were collected at the time of ACLF diagnosis and at 3-7 days thereafter, as well as in-hospital and 28-day mortality.
RESULTS: Eighty nine out of 354 admission episodes (28%) developed ACLF, which was present at the time of admission in 72% of cases. A precipitating factor was identified in 83% of cases, the most frequent being infection (53%) and gastrointestinal bleeding (19%). In the multivariate regression analysis, the ACLF grade at 3-7 days after diagnosis was predictive of in-hospital mortality and 28-day mortality, and lower creatinine and bilirubin levels at the time of ACLF diagnosis and a precipitating factor other than bacterial infection were associated with ACLF reversion at 3-7 days.
CONCLUSIONS: ACLF is a frequent complication among patients with chronic liver disease admitted for acute decompensations and is associated with a high mortality rate and is related to the number of organs involved. Bacterial infection is the most frequent precipitating factor of ACLF and probably entails a worse prognosis.
摘要：
背景：慢性急性肝衰竭（ACLF）是一种常见的综合征，发生在晚期慢性肝病患者中。它包括各种器官的快速衰竭，并与高短期死亡率有关。我们旨在描述发生ACLF的住院患者的主要特征和结局，并确定与住院和28天死亡率相关的因素。
方法：确定2014年1月至2016年12月收治的符合ACLF标准的晚期慢性肝病失代偿患者。在ACLF诊断时和之后3-7天收集临床和生物学数据,以及住院和28天死亡率。
结果：354次入院发作中有89次（28％）发展为ACLF，72％的病例在入院时存在。在83%的病例中发现了一个诱发因素，最常见的是感染(53%)和消化道出血(19%)。在多元回归分析中，诊断后3-7天的ACLF分级可预测院内死亡率和28天死亡率,ACLF诊断时较低的肌酐和胆红素水平以及细菌感染以外的其他诱发因素与3-7天的ACLF逆转相关。
结论：ACLF是因急性失代偿而入院的慢性肝病患者的常见并发症，与高死亡率相关，并且与受累器官的数量有关。细菌感染是ACLF最常见的诱发因素，可能导致预后较差。
方法：确定2014年1月至2016年12月收治的符合ACLF标准的晚期慢性肝病失代偿患者。在ACLF诊断时和之后3-7天收集临床和生物学数据,以及住院和28天死亡率。
结果：354次入院发作中有89次（28％）发展为ACLF，72％的病例在入院时存在。在83%的病例中发现了一个诱发因素，最常见的是感染(53%)和消化道出血(19%)。在多元回归分析中，诊断后3-7天的ACLF分级可预测院内死亡率和28天死亡率,ACLF诊断时较低的肌酐和胆红素水平以及细菌感染以外的其他诱发因素与3-7天的ACLF逆转相关。
结论：ACLF是因急性失代偿而入院的慢性肝病患者的常见并发症，与高死亡率相关，并且与受累器官的数量有关。细菌感染是ACLF最常见的诱发因素，可能导致预后较差。
