Nationwide survey for patients with acute-on-chronic liver failure occurring between 2017 and 2019 and diagnosed according to proposed Japanese criteria
© 2021. Japanese Society of Gastroenterology..
BACKGROUND: The significance of the 2018 Japanese diagnostic criteria for acute-on-chronic liver failure (ACLF) has not yet been evaluated.
METHODS: A nationwide survey was performed for patients with ACLF occurring between 2017 and 2019. Cirrhotic patients with a Child-Pugh score of 5-9 were diagnosed as having ACLF when liver failure (serum bilirubin level of ≥ 5.0 mg/dL and a prothrombin time international normalization rate [INR] of ≥ 1.5) occurred within 28 days after an acute insult. Patients who fulfilled either criterion (total serum bilirubin or INR) and/or those with indeterminate Child-Pugh scores at baseline were also enrolled.
RESULTS: Among the 501 enrolled patients, 183 patients (37%) were diagnosed as having ACLF. The etiologies of the cirrhosis and acute insults were alcohol intake/abuse in 114 (62%) and 75 (41%) patients, respectively. Sixty-eight patients (37%) were also diagnosed as having severe alcoholic hepatitis. The survival rate without liver transplantation was 48% among the ACLF patients and 71% in the remaining patients (P < 0.01). A multivariate analysis revealed that the disease condition was significantly associated with mortality, with an odds ratio of 2.025 in ACLF patients relative to the remaining patients (P < 0.01), and patient age and the number of organs with functional failure were also associated with mortality among the ACLF patients.
CONCLUSION: The proposed diagnostic criteria for ACLF were useful for identifying cirrhotic patients with an unfavorable outcome following acute insults. A therapeutic strategy for patients with severe alcoholic hepatitis should be established, since such patients accounted for the majority of ACLF patients.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:56 |
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| Enthalten in: |
Journal of gastroenterology - 56(2021), 12 vom: 05. Dez., Seite 1092-1106 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Nakayama, Nobuaki [VerfasserIn] |
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| Links: |
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| Themen: |
ACLF |
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| Anmerkungen: |
Date Completed 23.03.2022 Date Revised 23.03.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1007/s00535-021-01834-8 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM332776581 |
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| 100 | 1 | |a Nakayama, Nobuaki |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Nationwide survey for patients with acute-on-chronic liver failure occurring between 2017 and 2019 and diagnosed according to proposed Japanese criteria |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 23.03.2022 | ||
| 500 | |a Date Revised 23.03.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2021. Japanese Society of Gastroenterology. | ||
| 520 | |a BACKGROUND: The significance of the 2018 Japanese diagnostic criteria for acute-on-chronic liver failure (ACLF) has not yet been evaluated | ||
| 520 | |a METHODS: A nationwide survey was performed for patients with ACLF occurring between 2017 and 2019. Cirrhotic patients with a Child-Pugh score of 5-9 were diagnosed as having ACLF when liver failure (serum bilirubin level of ≥ 5.0 mg/dL and a prothrombin time international normalization rate [INR] of ≥ 1.5) occurred within 28 days after an acute insult. Patients who fulfilled either criterion (total serum bilirubin or INR) and/or those with indeterminate Child-Pugh scores at baseline were also enrolled | ||
| 520 | |a RESULTS: Among the 501 enrolled patients, 183 patients (37%) were diagnosed as having ACLF. The etiologies of the cirrhosis and acute insults were alcohol intake/abuse in 114 (62%) and 75 (41%) patients, respectively. Sixty-eight patients (37%) were also diagnosed as having severe alcoholic hepatitis. The survival rate without liver transplantation was 48% among the ACLF patients and 71% in the remaining patients (P < 0.01). A multivariate analysis revealed that the disease condition was significantly associated with mortality, with an odds ratio of 2.025 in ACLF patients relative to the remaining patients (P < 0.01), and patient age and the number of organs with functional failure were also associated with mortality among the ACLF patients | ||
| 520 | |a CONCLUSION: The proposed diagnostic criteria for ACLF were useful for identifying cirrhotic patients with an unfavorable outcome following acute insults. A therapeutic strategy for patients with severe alcoholic hepatitis should be established, since such patients accounted for the majority of ACLF patients | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ACLF | |
| 650 | 4 | |a Alcoholic hepatitis | |
| 650 | 4 | |a Liver transplantation | |
| 650 | 4 | |a Multiple organ failure | |
| 700 | 1 | |a Uemura, Hayato |e verfasserin |4 aut | |
| 700 | 1 | |a Uchida, Yoshihito |e verfasserin |4 aut | |
| 700 | 1 | |a Imai, Yukinori |e verfasserin |4 aut | |
| 700 | 1 | |a Tomiya, Tomoaki |e verfasserin |4 aut | |
| 700 | 1 | |a Terai, Shuji |e verfasserin |4 aut | |
| 700 | 1 | |a Yoshiji, Hitoshi |e verfasserin |4 aut | |
| 700 | 1 | |a Genda, Takuya |e verfasserin |4 aut | |
| 700 | 1 | |a Ido, Akio |e verfasserin |4 aut | |
| 700 | 1 | |a Inoue, Kazuaki |e verfasserin |4 aut | |
| 700 | 1 | |a Kato, Naoya |e verfasserin |4 aut | |
| 700 | 1 | |a Sakaida, Isao |e verfasserin |4 aut | |
| 700 | 1 | |a Shimizu, Masahito |e verfasserin |4 aut | |
| 700 | 1 | |a Takikawa, Yasuhiro |e verfasserin |4 aut | |
| 700 | 1 | |a Abe, Masanori |e verfasserin |4 aut | |
| 700 | 1 | |a Abe, Ryuzo |e verfasserin |4 aut | |
| 700 | 1 | |a Chayama, Kazuaki |e verfasserin |4 aut | |
| 700 | 1 | |a Hasegawa, Kiyoshi |e verfasserin |4 aut | |
| 700 | 1 | |a Inui, Ayano |e verfasserin |4 aut | |
| 700 | 1 | |a Kasahara, Mureo |e verfasserin |4 aut | |
| 700 | 1 | |a Ohira, Hiromasa |e verfasserin |4 aut | |
| 700 | 1 | |a Tanaka, Atsushi |e verfasserin |4 aut | |
| 700 | 1 | |a Takikawa, Hajime |e verfasserin |4 aut | |
| 700 | 1 | |a Mochida, Satoshi |e verfasserin |4 aut | |
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