Outcomes of patients with acute liver failure not listed for liver transplantation: A cohort analysis.

IF 5.6 2区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY
Hepatology Communications Pub Date : 2024-10-30 eCollection Date: 2024-11-01 DOI:10.1097/HC9.0000000000000575
Victor Dong, Valerie Durkalski, William M Lee, Constantine J Karvellas
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引用次数: 0

Abstract

Background: Acute liver failure (ALF) is a rare condition leading to morbidity and mortality. Liver transplantation (LT) is often required, but patients are not always listed for LT. There is a lack of data regarding outcomes in these patients. Our aim is to describe outcomes of patients with ALF not listed for LT and to compare this with those listed for LT.

Methods: Retrospective analysis of all nonlisted patients with ALF enrolled in the Acute Liver Failure Study Group (ALFSG) registry between 1998 and 2018. The primary outcome was 21-day mortality. Multivariable logistic regression was done to identify factors associated with 21-day mortality. The comparison was then made with patients with ALF listed for LT.

Results: A total of 1672 patients with ALF were not listed for LT. The median age was 41 (IQR: 30-54). Three hundred seventy-one (28.9%) patients were too sick to list. The most common etiology was acetaminophen toxicity (54.8%). Five hundred fifty-eight (35.7%) patients died at 21 days. After adjusting for relevant covariates, King's College Criteria (adjusted odds ratio: 3.17, CI 2.23-4.51), mechanical ventilation (adjusted odds ratio: 1.53, CI: 1.01-2.33), and vasopressors (adjusted odds ratio: 2.10, CI: 1.43-3.08) (p < 0.05 for all) were independently associated with 21-day mortality. Compared to listed patients, nonlisted patients had higher mortality (35.7% vs. 24.3%). Patients deemed not sick enough had greater than 95% survival, while those deemed too sick still had >30% survival.

Conclusions: Despite no LT, the majority of patients were alive at 21 days. Survival was lower in nonlisted patients. Clinicians are more accurate in deeming patients not sick enough to require LT as opposed to deeming patients too sick to survive.

未列入肝移植名单的急性肝衰竭患者的预后:队列分析
背景:急性肝衰竭(ALF)是一种罕见的疾病,可导致发病率和死亡率。通常需要进行肝移植(LT),但患者并不总是被列入肝移植名单。有关这些患者预后的数据十分缺乏。我们的目的是描述未列入肝移植名单的 ALF 患者的治疗效果,并与列入肝移植名单的患者进行比较:回顾性分析1998年至2018年间急性肝衰竭研究组(ALFSG)登记的所有未列入名单的ALF患者。主要结果为 21 天死亡率。通过多变量逻辑回归确定与 21 天死亡率相关的因素。然后与列入LT的ALF患者进行比较:共有1672名ALF患者未被列为LT患者。中位年龄为 41 岁(IQR:30-54)。有 371 名(28.9%)患者因病情严重而无法列入名单。最常见的病因是对乙酰氨基酚中毒(54.8%)。558名患者(35.7%)在21天后死亡。在对相关协变量进行调整后,国王学院标准(调整后的几率比:3.17,CI:2.23-4.51)、机械通气(调整后的几率比:1.53,CI:1.01-2.33)和血管加压剂(调整后的几率比:2.10,CI:1.43-3.08)(所有几率比均小于 0.05)与 21 天死亡率独立相关。与列入名单的患者相比,未列入名单的患者死亡率更高(35.7% 对 24.3%)。被认为病情不够严重的患者存活率超过95%,而被认为病情过于严重的患者存活率仍大于30%:结论:尽管没有进行LT治疗,但大多数患者在21天后仍然存活。结论:尽管没有进行LT治疗,但大多数患者在21天后仍然存活,未被列入名单的患者存活率较低。相对于认为病情太重而无法存活的患者,临床医生认为病情不够严重而不需要进行LT的判断更为准确。
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来源期刊
Hepatology Communications
Hepatology Communications GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
8.00
自引率
2.00%
发文量
248
审稿时长
8 weeks
期刊介绍: Hepatology Communications is a peer-reviewed, online-only, open access journal for fast dissemination of high quality basic, translational, and clinical research in hepatology. Hepatology Communications maintains high standard and rigorous peer review. Because of its open access nature, authors retain the copyright to their works, all articles are immediately available and free to read and share, and it is fully compliant with funder and institutional mandates. The journal is committed to fast publication and author satisfaction. ​
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