慢加急性肝衰竭长期预后转归的等级分析:同病不同结局

Prognostic grade of acute-on-chronic liver failure:Different outcomes of the same disease

慢加急性肝衰竭(ACLF)是在慢性肝病基础上发生的急性肝功能失代偿,伴随着器官功能衰竭和短期高死亡率为特点的复杂临床综合征。ACLF病程有长有短,疾病具有可逆转性,患者长期预后转归结局多样化,临床医生应尽早准确评估患者的预后,以优化治疗方案,提高患者生存率。就ACLF患者预后长期转归首次进行5个等级的描述:Ⅰ级为理想的结局:无肝硬化;Ⅱ级为满意的结局:代偿性肝硬化,表现为可逆转的肝硬化或持续代偿性的肝硬化;Ⅲ级为可接受的结局:失代偿性肝硬化,表现为失代偿性肝硬化或慢性肝衰竭;Ⅳ级为移植后存活结局;Ⅴ级为死亡结局,以期为临床长期预后结局判断提供参考。

Acute-on-chronic liver failure(ACLF)is a complex clinical syndrome characterized by acute liver function decompensation on the basis of chronic liver diseases,with organ failure and a high short-term mortality rate.The course of ACLF varies across patients,and the disease is reversible.Patients tend to have diverse long-term outcomes,and clinicians should evaluate the prognosis of patients as early as possible to optimize treatment regimen and improve survival rate.This article describes the following five grades of the long-term prognosis of patients with ACLF for the first time:grade I is the ideal outcome of no cirrhosis;grade II is the satisfactory outcome of compensated liver cirrhosis manifesting as reversible liver cirrhosis or persistent compensated liver cirrhosis;grade III is the acceptable outcome of decompensated liver cirrhosis manifesting as decompensated liver cirrhosis or chronic liver failure;grade IV is the outcome of survival after transplantation;grade V is the outcome of death.This article aims to provide a reference for judging long-term clinical prognosis.