The Natural History of Severe Acute Liver Injury

被引：116

作者：

Koch, David G. ^{[1
]}

Speiser, J. L. ^{[1
]}

Durkalski, V. ^{[1
]}

Fontana, R. J. ^{[2
]}

Davern, T. ^{[3
]}

McGuire, B. ^{[4
]}

Stravitz, R. T. ^{[5
]}

Larson, A. M. ^{[6
]}

Liou, I. ^{[6
]}

Fix, O. ^{[7
]}

Schilsky, M. L. ^{[8
]}

McCashland, T. ^{[9
]}

Hay, J. E. ^{[10
]}

Murray, N. ^{[11
]}

Shaikh, O. S. ^{[12
]}

Ganger, D. ^{[13
]}

Zaman, A. ^{[14
]}

Han, S. B. ^{[15
]}

Chung, R. T. ^{[16
]}

Brown, R. S. ^{[17
]}

Munoz, S., Jr. ^{[18
]}

Reddy, K. R. ^{[18
]}

Rossaro, L. ^{[19
]}

Satyanarayana, R. ^{[20
]}

Hanje, A. J. ^{[21
]}

Olson, J. ^{[22
]}

Subramanian, R. M. ^{[23
]}

Karvellas, C. ^{[24
]}

Hameed, B. ^{[25
]}

Sherker, A. H. ^{[26
]}

Lee, W. M. ^{[27
]}

Reuben, A. ^{[1
]}

机构：

[1] Med Univ South Carolina, Charleston, SC 29425 USA

[2] Univ Michigan, Ann Arbor, MI 48109 USA

[3] Calif Pacific Med Ctr, San Francisco, CA USA

[4] Univ Alabama Birmingham, Birmingham, AL USA

[5] Virginia Commonwealth Univ, Richmond, VA USA

[6] Univ Washington, Seattle, WA 98195 USA

[7] Swedish Med Ctr Seattle, Seattle, WA USA

[8] Yale Univ, New Haven, CT USA

[9] Univ Nebraska Med Ctr, Omaha, NE USA

[10] Mayo Clin, Rochester, MN USA

[11] Baylor Univ, Med Ctr, Dallas, TX USA

[12] Univ Pittsburgh, Pittsburgh, PA USA

[13] Northwestern Univ, Evanston, IL USA

[14] Oregon Hlth & Sci Univ, Portland, OR USA

[15] Univ Calif Los Angeles, Los Angeles, CA USA

[16] Massachusetts Gen Hosp, Boston, MA 02114 USA

[17] Albert Einstein Med Ctr, Philadelphia, PA 19141 USA

[18] Univ Penn, Philadelphia, PA 19104 USA

[19] Univ Calif Davis, Davis, CA 95616 USA

[20] Mayo Clin, Jacksonville, FL 32224 USA

[21] Ohio State Univ, Columbus, OH USA

[22] Univ Kansas, Med Ctr, Kansas City, KS 66103 USA

[23] Emory Univ, Atlanta, GA 30322 USA

[24] Univ Alberta, Edmonton, AB, Canada

[25] Univ Calif San Francisco, San Francisco, CA 94143 USA

[26] NIDDK, Bethesda, MD 20892 USA

[27] Univ Texas Southwestern Med Ctr Dallas, Dallas, TX 75390 USA

来源：

AMERICAN JOURNAL OF GASTROENTEROLOGY | 2017年 / 112卷 / 09期

关键词：

ACUTE HEPATITIS; FAILURE; HEMOSTASIS; CORTICOSTEROIDS; CLASSIFICATION; DIAGNOSIS; MORTALITY; PREDICT;

D O I：

10.1038/ajg.2017.98

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

100201 [内科学];

摘要：

OBJECTIVES: Acute liver failure (ALF) is classically defined by coagulopathy and hepatic encephalopathy (HE); however, acute liver injury (ALI), i.e., severe acute hepatocyte necrosis without HE, has not been carefully defined nor studied. Our aim is to describe the clinical course of specifically defined ALI, including the risk and clinical predictors of poor outcomes, namely progression to ALF, the need for liver transplantation (LT) and death. METHODS: 386 subjects prospectively enrolled in the Acute Liver Failure Study Group registry between 1 September 2008 through 25 October 2013, met criteria for ALI: International Normalized Ratio (INR) >= 2.0 and alanine aminotransferase (ALT) >= 10xelevated (irrespective of bilirubin level) for acetaminophen (N-acetyl-p-aminophenol, APAP) ALI, or INR >= 2.0, ALT >= 10x elevated, and bilirubin >= 3.0 mg/dl for non-APAP ALI, both groups without any discernible HE. Subjects who progressed to poor outcomes (ALF, death, LT) were compared, by univariate analysis, with those who recovered. A model to predict poor outcome was developed using the random forest (RF) procedure. RESULTS: Progression to a poor outcome occurred in 90/386 (23%), primarily in non-APAP (71/179, 40%) vs. only 14/194 (7.2%) in APAP patients comprising 52% of all cases (13 cases did not have an etiology assigned; 5 of whom had a poor outcome). Of 82 variables entered into the RF procedure: etiology, bilirubin, INR, APAP level and duration of jaundice were the most predictive of progression to ALF, LT, or death. CONCLUSIONS: A majority of ALI cases are due to APAP, 93% of whom will improve rapidly and fully recover, while non-APAP patients have a far greater risk of poor outcome and should be targeted for early referral to a liver transplant center.

引用

页码：1389 / 1396

页数：8

共 29 条

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