Frequency and Outcomes of Acute-on-Chronic Liver Failure in Nonelective Cirrhotic Patients Admitted to a Brazilian ICU: A Single-Center Retrospective Study.

IF 2.3 4区 医学 Q2 Medicine
Canadian Journal of Gastroenterology and Hepatology Pub Date : 2025-08-26 eCollection Date: 2025-01-01 DOI:10.1155/cjgh/9728104
Maria Eduarda Chaves Soares, Liana Codes, Bianca Sampaio de Carvalho, Amanda Caroline Silveira E Silva, Myriam Sofia Angeli Guimarães de Oliveira, Fabiola Santos Sousa, Mariana Rebouças de Calasans, Jade de Oliveira Santana, Lucas Celes Dominguez, Paulo Lisboa Bittencourt
{"title":"Frequency and Outcomes of Acute-on-Chronic Liver Failure in Nonelective Cirrhotic Patients Admitted to a Brazilian ICU: A Single-Center Retrospective Study.","authors":"Maria Eduarda Chaves Soares, Liana Codes, Bianca Sampaio de Carvalho, Amanda Caroline Silveira E Silva, Myriam Sofia Angeli Guimarães de Oliveira, Fabiola Santos Sousa, Mariana Rebouças de Calasans, Jade de Oliveira Santana, Lucas Celes Dominguez, Paulo Lisboa Bittencourt","doi":"10.1155/cjgh/9728104","DOIUrl":null,"url":null,"abstract":"<p><p><b>Introduction:</b> Acute-on-chronic liver failure (ACLF) is a severe complication of cirrhosis characterized by acute decompensation (AD), organ failure(s), and high mortality. <b>Aims:</b> To investigate the frequency and the clinical course of ACLF in intensive care unit (ICU) patients at different time points, using CLIF-C and NACSELD criteria as well as to assess their influence on mortality. <b>Methods:</b> Patients admitted with AD with and without ACLF were retrospectively evaluated. <b>Results:</b> 595 patients (443 males, mean age: 66.6 ± 12.0 years) were admitted due to AD (<i>n</i> = 381) or ACLF (<i>n</i> = 214). According to the CLIF-C criteria, 119 patients (20%) had ACLF Grade I, 63 (10.6%) had ACLF Grade II, and 32 (5.4%) had ACLF Grade III at admission. Using the NACSELD, 155 patients (26.1%) had ACLF at admission. Infection was the main factor associated with ACLF at admission (<i>n</i> = 57; 27%, <i>p</i> = 0.001). In total, 104 (17.5%) patients died during hospitalization. ACLF grade at admission (OR: 4.6; 95% CI: 2.45-8.67; NS: 0.0001), use of vasopressors (OR: 3.83; 95% CI: 1.15-12.7; NS: 0.02), and CLIF-C ACLF (OR: 1.12; 95% CI: 1.06-1.19; NS: 0.0001) were independently associated with in-hospital mortality. The improvement in organ dysfunction after 7 days of intensive care was associated with a reduction in the risk of in-hospital mortality compared to the 3-day period (OR: 0.098; 95% CI: 0.047-0.204 vs. 0.253; 95% CI: 0.127-0.504; <i>p</i> < 0.00001, respectively). <b>Conclusion:</b> ACLF is associated with significant mortality in ICU patients, the CLIF-C criteria appear to be more effective for prognostic assessment than NACSELD, and 7 days of intensive care may improve clinical outcomes.</p>","PeriodicalId":48755,"journal":{"name":"Canadian Journal of Gastroenterology and Hepatology","volume":"2025 ","pages":"9728104"},"PeriodicalIF":2.3000,"publicationDate":"2025-08-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12407287/pdf/","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Canadian Journal of Gastroenterology and Hepatology","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1155/cjgh/9728104","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2025/1/1 0:00:00","PubModel":"eCollection","JCR":"Q2","JCRName":"Medicine","Score":null,"Total":0}
引用次数: 0

Abstract

Introduction: Acute-on-chronic liver failure (ACLF) is a severe complication of cirrhosis characterized by acute decompensation (AD), organ failure(s), and high mortality. Aims: To investigate the frequency and the clinical course of ACLF in intensive care unit (ICU) patients at different time points, using CLIF-C and NACSELD criteria as well as to assess their influence on mortality. Methods: Patients admitted with AD with and without ACLF were retrospectively evaluated. Results: 595 patients (443 males, mean age: 66.6 ± 12.0 years) were admitted due to AD (n = 381) or ACLF (n = 214). According to the CLIF-C criteria, 119 patients (20%) had ACLF Grade I, 63 (10.6%) had ACLF Grade II, and 32 (5.4%) had ACLF Grade III at admission. Using the NACSELD, 155 patients (26.1%) had ACLF at admission. Infection was the main factor associated with ACLF at admission (n = 57; 27%, p = 0.001). In total, 104 (17.5%) patients died during hospitalization. ACLF grade at admission (OR: 4.6; 95% CI: 2.45-8.67; NS: 0.0001), use of vasopressors (OR: 3.83; 95% CI: 1.15-12.7; NS: 0.02), and CLIF-C ACLF (OR: 1.12; 95% CI: 1.06-1.19; NS: 0.0001) were independently associated with in-hospital mortality. The improvement in organ dysfunction after 7 days of intensive care was associated with a reduction in the risk of in-hospital mortality compared to the 3-day period (OR: 0.098; 95% CI: 0.047-0.204 vs. 0.253; 95% CI: 0.127-0.504; p < 0.00001, respectively). Conclusion: ACLF is associated with significant mortality in ICU patients, the CLIF-C criteria appear to be more effective for prognostic assessment than NACSELD, and 7 days of intensive care may improve clinical outcomes.

巴西ICU收治的非选择性肝硬化患者急性-慢性肝衰竭的频率和结果:一项单中心回顾性研究
急性慢性肝衰竭(ACLF)是肝硬化的一种严重并发症,其特征是急性失代偿(AD)、器官衰竭(s)和高死亡率。目的:采用CLIF-C和NACSELD标准,探讨重症监护病房(ICU)患者不同时间点发生ACLF的频率和临床病程,并评估其对死亡率的影响。方法:回顾性分析伴有和不伴有ACLF的AD患者。结果:595例患者(男性443例,平均年龄66.6±12.0岁)因AD (n = 381)或ACLF (n = 214)入院。根据CLIF-C标准,入院时ACLF I级119例(20%),II级63例(10.6%),III级32例(5.4%)。使用NACSELD, 155例患者(26.1%)在入院时发生ACLF。入院时感染是与ACLF相关的主要因素(n = 57; 27%, p = 0.001)。共有104例(17.5%)患者在住院期间死亡。入院时ACLF分级(OR: 4.6; 95% CI: 2.45-8.67; NS: 0.0001)、血管加压药物的使用(OR: 3.83; 95% CI: 1.15-12.7; NS: 0.02)和CLIF-C ACLF (OR: 1.12; 95% CI: 1.06-1.19; NS: 0.0001)与住院死亡率独立相关。与3天期间相比,7天重症监护后器官功能障碍的改善与院内死亡风险的降低相关(OR: 0.098; 95% CI: 0.047-0.204 vs. 0.253; 95% CI: 0.127-0.504; p < 0.00001)。结论:ACLF与ICU患者的显著死亡率相关,ccliff - c标准似乎比NACSELD更有效地用于预后评估,7天的重症监护可能改善临床结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
求助全文
约1分钟内获得全文 求助全文
来源期刊
CiteScore
4.80
自引率
0.00%
发文量
0
审稿时长
37 weeks
期刊介绍: Canadian Journal of Gastroenterology and Hepatology is a peer-reviewed, open access journal that publishes original research articles, review articles, and clinical studies in all areas of gastroenterology and liver disease - medicine and surgery. The Canadian Journal of Gastroenterology and Hepatology is sponsored by the Canadian Association of Gastroenterology and the Canadian Association for the Study of the Liver.
×
引用
GB/T 7714-2015
复制
MLA
复制
APA
复制
导出至
BibTeX EndNote RefMan NoteFirst NoteExpress
×
提示
您的信息不完整,为了账户安全,请先补充。
现在去补充
×
提示
您因"违规操作"
具体请查看互助需知
我知道了
×
提示
确定
请完成安全验证×
copy
已复制链接
快去分享给好友吧!
我知道了
右上角分享
点击右上角分享
0
联系我们:info@booksci.cn Book学术提供免费学术资源搜索服务,方便国内外学者检索中英文文献。致力于提供最便捷和优质的服务体验。 Copyright © 2023 布克学术 All rights reserved.
京ICP备2023020795号-1
ghs 京公网安备 11010802042870号
Book学术文献互助
Book学术文献互助群
群 号:604180095
Book学术官方微信