目的:慢性急性肝衰竭(ACLF)是一个主要的公共卫生问题。我们旨在评估定义,病因谱,器官衰竭(OF),以及全球ACLF的结果。
方法:从1990年至2022年9月,搜索了三个数据库中关于ACLF的研究。有关定义的信息,急性沉淀剂,潜在的慢性肝病(CLD),OF,和死亡率被提取。对合并患病率进行荟萃分析(95%置信区间,CI)对ACLF的每个定义使用随机效应模型。
结果:在确定的11,451项研究中,114篇文章(142个队列,包括210,239名患者)符合资格标准。大多数研究(53.2%)使用了欧洲肝脏研究协会(EASL)的定义,其次是亚太肝脏研究协会(APASL)(33.3%)。在EASL定义的研究中,全身性感染是主要的急性诱发因素,酒精使用是CLD的主要原因,而酒精是两者,APASL定义的研究中CLD的主要急性诱发因素和原因。在基于APASL的研究中,肝功能衰竭是主要的,而在基于EASL的研究中,肾衰竭占主导地位。30天死亡率因定义而异:APASL:38.9%[95CI31.2-46.9],EASL:47.9%[95CI42.2-53.5]和NACSELD:52.2%[95CI51.9-52.5]。定义之间的诊断重叠范围为7.7%至80.2%。Meta回归表明,在使用EASL定义的研究中,WHO地区影响了30天死亡率。
结论:不同专家协会提出的ACLF定义的异质性和使用的地区偏好导致临床表型和结果的差异。统一的定义将增强全球数据的可比性和解释。
OBJECTIVE: Acute-on-chronic liver failure (ACLF) is a major public health concern. We aimed to assess the definitions, etiologic spectrum, organ failure (OF), and outcomes of ACLF globally.
METHODS: Three databases were searched for studies on ACLF from 1990 until September 2022. Information regarding definitions, acute precipitants, underlying chronic liver disease (CLD), OF, and mortality were extracted. Meta-analyses were performed for pooled prevalence rates (95% confidence interval [CI]) using random-effects model for each definition of ACLF.
RESULTS: Of the 11,451 studies identified, 114 articles (142 cohorts encompassing 210,239 patients) met the eligibility criteria. Most studies (53.2%) used the European Association for the Study of the Liver (EASL) definition, followed by Asia-Pacific Association for the Study of the Liver (
APASL) (33.3%). Systemic infection was the major acute precipitant, and alcohol use was the major cause of CLD in EASL-defined studies, whereas alcohol was both the major acute precipitant and cause of CLD in
APASL-defined studies. Liver failure was the major OF in
APASL-based studies, whereas renal failure was predominant in EASL-based studies. Thirty-day mortality varied across definitions:
APASL: 38.9%, 95% CI, 31.2%-46.9%; EASL: 47.9%, 95% CI, 42.2%-53.5%; and NACSELD: 52.2%, 95% CI, 51.9%-52.5%. Diagnostic overlap between definitions ranged from 7.7% to 80.2%. Meta-regression suggested that the World Health Organization region influenced 30-day mortality in studies using EASL definition.
CONCLUSIONS: Heterogeneity in the definition of ACLF proposed by different expert societies and regional preferences in its use result in differences in clinical phenotype and outcomes. A uniform definition would enhance the comparability and interpretation of global data.