未经证实:急性-慢性肝功能衰竭(ACLF)是急性失代偿(AD)和ACLF之间的明显中间阶段。然而,识别前ACLF患者和预测从AD到ACLF的进展是困难的.本研究旨在在28天内识别前ACLF,并开发和验证HBV相关失代偿期肝硬化患者ACLF的预测模型。
未经批准:总共,1,736例HBV相关性肝硬化和AD患者从2个大规模,多中心,前瞻性队列。28天内发生ACLF,重新接纳,收集3个月和1年结局.
UASSIGNED:在衍生队列中970例无ACLF的AD患者中,94例(9.6%)ACLF前患者的3个月和1年无LT死亡率最高(61.6%和70.9%,分别),这与ACLF在入学时(57.1%和67.1%)相当;251(25.9%)不稳定失代偿期肝硬化患者的死亡率为22.4%和32.1%,分别;而507例(57.9%)稳定的失代偿期肝硬化患者的结局最好(1年死亡率为2.6%)。通过Cox比例风险回归,特定的沉淀剂,包括乙肝病毒再激活的乙肝病毒耀斑,自发性乙型肝炎耀斑病毒载量高,HBV叠加感染,和细菌感染,在派生队列中被确定为与ACLF发生显著相关。一个包含沉淀剂的模型,在推导和验证队列中,全身性炎症和器官损伤的指标达到了0.90和0.86的高C指数,分别。最佳临界值(0.22)区分高风险和低风险患者,阴性预测值为0.95。
UNASSIGNED:在HBV病因人群中验证了AD患者的三个不同的临床过程。沉淀剂显著影响AD-ACLF转变。由诱发性-全身性炎症-器官损伤框架开发的模型可能是预测ACLF发生的有用工具。
UNASSIGNED:NCT02457637和NCT03641872。
UNASSIGNED:以前的研究表明,失代偿期肝硬化患者可以根据其短期临床预后分为3组。在这里,我们表明,这种分层适用于因乙型肝炎病毒感染而发展为肝硬化的患者。我们还开发了一种基于沉淀剂的模型(即,结合有关代偿失调的确切原因的信息的模型),可以预测这些患者发展为称为慢性急性肝衰竭(或ACLF)的非常严重的肝病的可能性。
UNASSIGNED: Pre-acute-on-chronic liver failure (ACLF) is a distinct intermediate stage between acute decompensation (AD) and ACLF. However, identifying patients with pre-ACLF and predicting progression from AD to ACLF is difficult. This study aimed to identify pre-ACLF within 28 days, and to develop and validate a prediction model for ACLF in patients with HBV-related decompensated cirrhosis.
UNASSIGNED: In total, 1,736 patients with HBV-related cirrhosis and AD were enrolled from 2 large-scale, multicenter, prospective cohorts. ACLF occurrence within 28 days, readmission, and 3-month and 1-year outcomes were collected.
UNASSIGNED: Among 970 patients with AD without ACLF in the derivation cohort, the 94 (9.6%) patients with pre-ACLF had the highest 3-month and 1-year LT-free mortality (61.6% and 70.9%, respectively), which was comparable to those with ACLF at enrollment (57.1% and 67.1%); the 251 (25.9%) patients with unstable decompensated cirrhosis had mortality rates of 22.4% and 32.1%, respectively; while the 507 (57.9%) patients with stable decompensated cirrhosis had the best outcomes (1-year mortality rate of 2.6%). Through Cox proportional hazard regression, specific precipitants, including hepatitis B flare with HBV reactivation, spontaneous hepatitis B flare with high viral load, superimposed infection on HBV, and bacterial infection, were identified to be significantly associated with ACLF occurrence in the derivation cohort. A model that incorporated precipitants, indicators of systemic inflammation and organ injuries reached a high C-index of 0.90 and 0.86 in derivation and validation cohorts, respectively. The optimal cut-off value (0.22) differentiated high-risk and low-risk patients, with a negative predictive value of 0.95.
UNASSIGNED: Three distinct clinical courses of patients with AD are validated in the HBV-etiology population. The precipitants significantly impact on AD-ACLF transition. A model developed by the precipitant-systemic inflammation-organ injury framework could be a useful tool for predicting ACLF occurrence.
UNASSIGNED: NCT02457637 and NCT03641872.
UNASSIGNED: It was previously shown that patients with decompensated cirrhosis could be stratified into 3 groups based on their short-term clinical prognoses. Herein, we showed that this stratification applies to patients who develop cirrhosis as a result of hepatitis B virus infection. We also developed a precipitant-based model (i.e. a model that incorporated information about the exact cause of decompensation) that could predict the likelihood of these patients developing a very severe liver disease called acute-on-chronic liver failure (or ACLF).