2004年成立的亚太肝脏研究协会(APASL)工作组关于慢性急性肝衰竭(ACLF)的第一份共识报告于2009年发表。随着国际团体的自愿加入,“APASLACLF研究联盟(AARC)”成立于2012年,继续收集前瞻性ACLF患者数据.基于近1400例患者的前瞻性数据分析,AARC共识于2014年发布。在过去近四年半的时间里,亚洲各主要肝病中心已将AARC数据库充实到约5200例病例.对过渡时期发布的数据进行了仔细分析,并以系统的方式优先考虑了ACLF领域的争议领域和新发展。还接触了AARC数据库,以回答已发布数据有限的一些问题,如肝功能衰竭分级,它对“黄金治疗之窗”的影响,肝外器官功能障碍和衰竭,脓毒症的发展,ACLF和小儿ACLF急性失代偿的特点及存在的问题进行了分析。这些举措于2018年10月在新德里举行的为期两天的会议上结束,最终确定了新的AARC共识。只有这些声明,这是基于使用评分系统的证据,并得到了一致推荐,被接受了。最终的陈述再次分发给所有专家,随后于2018年11月在AASLD的AARC调查人员会议上提交。专家们的建议被用来修订和最后确定共识。经过详细的审议和数据分析,ACLF的原始定义被发现经得起时间的检验,并且能够识别出现肝功能衰竭的同质患者组.新的管理选项,包括管理凝血障碍的算法,肾脏替代疗法,脓毒症,静脉曲张出血,提出了ACLF患者的抗病毒药物和肝移植标准.此处介绍了最终共识声明以及相关背景信息和需要未来研究的领域。
The first
consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. With international groups volunteering to join, the \"APASL ACLF Research Consortium (AARC)\" was formed in 2012, which continued to collect prospective ACLF patient data. Based on the prospective data analysis of nearly 1400 patients, the AARC
consensus was published in 2014. In the past nearly four-and-a-half years, the AARC database has been enriched to about 5200 cases by major hepatology centers across Asia. The data published during the interim period were carefully analyzed and areas of contention and new developments in the field of ACLF were prioritized in a systematic manner. The AARC database was also approached for answering some of the issues where published data were limited, such as liver failure grading, its impact on the \'Golden Therapeutic Window\', extrahepatic organ dysfunction and failure, development of sepsis, distinctive features of acute decompensation from ACLF and pediatric ACLF and the issues were analyzed. These initiatives concluded in a two-day meeting in October 2018 at New Delhi with finalization of the new AARC
consensus. Only those statements, which were based on evidence using the Grade System and were unanimously recommended, were accepted. Finalized statements were again circulated to all the experts and subsequently presented at the AARC investigators meeting at the AASLD in November 2018. The suggestions from the experts were used to revise and finalize the
consensus. After detailed deliberations and data analysis, the original definition of ACLF was found to withstand the test of time and be able to identify a homogenous group of patients presenting with liver failure. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals and criteria for liver transplantation for ACLF patients were proposed. The final
consensus statements along with the relevant background information and areas requiring future studies are presented here.