Role of predisposition, injury, response and organ failure in the prognosis of patients with acute-on-chronic liver failure a prospective cohort study 英文参考文献.docVIP

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Role of predisposition, injury, response and organ failure in the prognosis of patients with acute-on-chronic liver failure a prospective cohort study 英文参考文献.doc

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Role of predisposition, injury, response and organ failure in the prognosis of patients with acute-on-chronic liver failure a prospective cohort study 英文参考文献

Jalanetal.CriticalCare2012,16:R227 /content/16/6/R227 RESEARCH OpenAccess Roleofpredisposition,injury,responseandorgan failureintheprognosisofpatientswithacute-on- chronicliverfailure:aprospectivecohortstudy RajivJalan1*?,VanessaStadlbauer1,2?,SambitSen1,LisaCheshire1,Yu-MeiChang3andRajeshwarPMookerjee1 Abstract Introduction:Acutedeteriorationofcirrhosisisassociatedwithhighmortalityratesparticularlyinthepatients whodeveloporganfailure(OF),aconditionthatisreferredtoasacute-on-chronicliverfailure(ACLF),whichis currentlynotcompletelydefined.Thisstudyaimedtodeterminetheroleofpredisposingfactors,thenatureofthe precipitatingillnessandinflammatoryresponseintheprogressiontoOFaccordingtothePIRO(predisposition, injury,response,organfailure)concepttodefinetheriskofin-hospitalmortality. Methods:Atotalof477patientsadmittedwithacutedeteriorationofcirrhosisfollowingadefinedprecipitant overa5.5-yearperiodwereprospectivelystudied.Baselineclinical,demographicandbiochemicaldatawere recordedforallpatientsandextendedserialdatafromthegroupthatprogressedtoOFwereanalysedtodefine theroleofPIROindeterminingin-hospitalmortality. Results:Onehundredandfifty-nine(33%)patientsdevelopedOF,ofwhom93patientsdied(58%)comparedwith 25/318(8%)deathsinthenon-OFgroup(P0.0001).ProgressiontoOFwasassociatedwithmoresevere underlyingliverdiseaseandinflammation.IntheOFgroup,previoushospitalisation(PofPIRO);severityof inflammationandlackofitsresolution(RofPIRO);andseverityoforganfailure(OofPIRO)wereassociatedwith significantlygreaterriskofdeath.InthepatientswhorecoveredfromOF,mortalityatthreeyearswasalmost universal. Conclusions:TheresultsofthisprospectivestudyshowsthattheoccurrenceofOFaltersthenaturalhistoryof cirrhosis.AclassificationbasedonthePIROconceptmayallowcategorizationofpatientsintodistinct pathophysiologicandprognosticgroupsandallowamultidimensionaldefinitionofACLF. Introduction thismultiorganfailurecanoccureitherasaslowgradually WHO projections estimate that liver cirrhosis will be progressive decom