Characteristics, Diagnosis and Prognosis of Acute-on-Chronic Liver Failure in Cirrhosis Associated to Hepatitis B.

The diagnostic and prognostic criteria of acute-on-chronic liver failure (ACLF) were developed in patients with no Hepatitis B virus (HBV) cirrhosis (CANONIC study). The aims of this study were to evaluate whether the diagnostic (CLIF-C organ failure score; CLIF-C OFs) criteria can be used to classify patients; and the prognostic score (CLIF-C ACLF score) could be used to provide prognostic information in HBV cirrhotic patients with ACLF. 890 HBV associated cirrhotic patients with acute decompensation (AD) were enrolled. Using the CLIF-C OFs, 33.7% (300 patients) were diagnosed as ACLF. ACLF was more common in the younger patients and in those with no previous history of decompensation. The most common organ failures were ‘hepatic’ and ‘coagulation’. As in the CANONIC study, 90-day mortality was extremely low in the non-ACLF patients compared with ACLF patients (4.6% vs 50%, p < 0.0001). ACLF grade and white cell count, were independent predictors of mortality. CLIF-C ACLFs accurately predicted short-term mortality, significantly better than the MELDs and a disease specific score generated for the HBV patients. Current study indicates that ACLF is a clinically and pathophysiology distinct even in HBV patients. Consequently, diagnostic criteria, prognostic scores and probably the management of ACLF should base on similar principles.

慢加急性肝衰竭（ACLF）的诊断和预后标准是在无乙型肝炎病毒（HBV）肝硬化的患者中制定的（CANONIC研究）。本研究的目的是评估诊断标准（CLIF - C器官衰竭评分；CLIF - C OFs）是否可用于对患者进行分类，以及预后评分（CLIF - C ACLF评分）是否可用于为HBV肝硬化合并ACLF的患者提供预后信息。890例HBV相关的肝硬化急性失代偿（AD）患者被纳入研究。使用CLIF - C OFs，33.7%（300例患者）被诊断为ACLF。ACLF在年轻患者以及无既往失代偿病史的患者中更为常见。最常见的器官衰竭是“肝脏”和“凝血”方面的衰竭。与CANONIC研究一样，非ACLF患者的90天死亡率与ACLF患者相比极低（4.6%对50%，p < 0.0001）。ACLF分级和白细胞计数是死亡率的独立预测因素。CLIF - C ACLF评分能准确预测短期死亡率，明显优于MELD评分以及为HBV患者制定的疾病特异性评分。当前研究表明，即使在HBV患者中，ACLF在临床和病理生理学上也是独特的。因此，ACLF的诊断标准、预后评分以及可能的治疗都应基于相似的原则。