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