《2023年欧洲肝病学会临床实践指南:慢加急性肝衰竭》摘译

Exerpts of European Association for the Study of the Liver clinical practice guidelines on acute-on-chronic liver failure in 2023

慢加急性肝衰竭(ACLF)直至2013年才形成相关描述,属于较新的概念。ACLF是肝硬化急性失代偿的一种严重表现,其特征是存在器官和(或)系统衰竭和短期高死亡风险。ACLF是由临床上显性(如已证实的微生物感染伴脓毒症、重症酒精性肝炎)或隐性的诱因引发的全身系统性炎症反应引起的。自ACLF被描述以来,一些重要的研究表明ACLF患者可能受益于肝移植,因此应通过接受适当的病因治疗和全面综合管理,包括在重症监护室(ICU)的器官系统支持,紧急稳定进行肝移植。制定本临床实践指南的目标是提供现有最可靠的证据,辅助ACLF患者管理的临床决策过程;为帮助临床医师识别ACLF,做出分诊决定(ICU与非ICU),识别和管理急性诱因,识别需要支持或替换的器官系统,确定重症监护无效的潜在标准,并为确定肝移植的潜在适应证提供建议。

Acute-on-chronic liver failure(ACLF),which was first described in 2013,is a severe form of acutely decompensated cirrhosis characterised by the existence of organ system failure(s)and a high risk of short-term mortality.ACLF is caused by an excessive systemic inflammatory response triggered by precipitants that are clinically apparent(e.g.,comfirmed microbial infection with sepsis,severe alcohol-related hepatitis)or not.Since the description of ACLF,some important studies have suggested that patients with ACLF may benefit from liver transplantation and should therefore be urgently stabilized for transplantation by receiving appropriate etiological treatment and comprehesive management,including support of organ systems in the intensive care unit(ICU).The goal of the present clinical practice guidelines is to provide the most reliable evidence available to assist the clinical decision-making process in the management of patients with ACLF,to make triage decisions(ICU vs.no ICU),to identify and manage acute precipitants,to identify organ systems that require support or replacement,to define potential criteria for futility of intensive care,and it also provides suggestions for identifying potential indications for liver transplantation.