METHODS: A multicentre retrospective study across four major tertiary care centres.
RESULTS: As many as 183 ALF patients (median age, 23 years; females, 43.1%; model for end-stage liver disease [MELD], 32.7) from January 2021 to December 2023 were included. Nineteen per cent had infection and 40.4% of patients satisfied King\'s College criteria (KCC) at admission. Most common cause for ALF was hepatitis A virus (HAV) (44.2%) followed by rodenticide poisoning (10.3%). Approximately 35% of patients each received either PLEx or CRRT. The 7, 14 and 21-day transplant-free survival probability was 65.5%, 60.1%, and 57.3%, respectively. Only 3.8% of patients underwent liver transplantation. On multivariable Cox regression analysis, hemoglobin (HR, 0.74 [0.63-0.87]), lactate (HR, 1.14 [1.03-1.26]), advanced hepatic encephalopathy (HE) (HR, 4.87 [1.89-12.5]) and fulfilling KCC [HR, 10.04 [4.57-22.06]) at admission were the independent predictors of mortality. A model including KCC + lactate + HE ≥ 3 with or without hemoglobin had an AUROC of 0.81-0.84 to predict mortality. In those who underwent PLEx, advanced HE (HR, 4.13 [1.75-9.7]), procalcitonin (HR, 1.18 [1.07-1.30]) and KCC (HR, 4.6 [1.6-13.1), while for those who received CRRT, lactate (HR, 1.37 [1.22-1.54]) and KCC (HR, 6.4 [2.5-15.8]) independently predicted mortality.
CONCLUSIONS: Hepatitis A virus is currently the most common cause for ALF in India, emphasizing the need for universal vaccination programmes. Spontaneous survival in tertiary care centres is 57%. LT rates were low.
方法:一项跨四个主要三级护理中心的多中心回顾性研究。
结果:多达183例ALF患者(中位年龄,23岁;女性,43.1%;终末期肝病模型[MELD],32.7)从2021年1月到2023年12月被包括在内。19%的患者感染,40.4%的患者在入院时符合国王学院标准(KCC)。ALF的最常见原因是甲型肝炎病毒(HAV)(44.2%),其次是杀鼠剂中毒(10.3%)。大约35%的患者接受PLEx或CRRT。7、14和21天无移植存活概率为65.5%,60.1%,57.3%,分别。只有3.8%的患者接受了肝移植。关于多变量Cox回归分析,血红蛋白(HR,0.74[0.63-0.87]),乳酸(HR,1.14[1.03-1.26]),晚期肝性脑病(HE)(HR,4.87[1.89-12.5])并履行KCC[人力资源,入院时10.04[4.57-22.06])是死亡率的独立预测因子。包括有或没有血红蛋白的KCC+乳酸+HE≥3的模型具有0.81-0.84的AUROC来预测死亡率。在那些接受PLEx的人中,高级HE(HR,4.13[1.75-9.7]),降钙素原(HR,1.18[1.07-1.30])和KCC(HR,4.6[1.6-13.1),而对于那些接受CRRT的人来说,乳酸(HR,1.37[1.22-1.54])和KCC(HR,6.4[2.5-15.8])独立预测死亡率。
结论:目前,甲型肝炎病毒是印度ALF的最常见原因,强调普遍疫苗接种计划的必要性。三级护理中心的自发生存率为57%。LT率很低。