【摘 要】
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Background and Aims: Acute-on-chronic liver failure (ACLF) is acute decompensation of liver function in the setting of chronic liver disease, and characterized by high short-term mortality. In this study, we sought to investi-gate the clinical course of p
【机 构】
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Fourth Department of Liver Disease(Difficult&Complicated Liver Diseases and Artificial Liver Center)
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Background and Aims: Acute-on-chronic liver failure (ACLF) is acute decompensation of liver function in the setting of chronic liver disease, and characterized by high short-term mortality. In this study, we sought to investi-gate the clinical course of patients at specific time points, and to propose dynamic prognostic criteria. Methods: We assessed the clinical course of 453 patients with ACLF dur-ing a 12-week follow-up period in this retrospective multi-center study. The clinical course of patients was defined as disease recovery, improvement, worsening or steady pat-terns based on the variation tendency in prothrombin activ-ity (PTA) and total bilirubin (TB) at different time points. Results: Resolution of PTA was observed in 231 patients (51％) at 12 weeks after the diagnosis of ACLF. Among the remaining patients, 66 (14.6％) showed improvement and 156 (34.4％) showed a steady or worsening course. In pa-tients with resolved PTA, the clinical course of TB exhibited resolved pattern in 95.2％, improved in 3.9％, and steady or worse in 0.8％. Correspondingly, in patients with im-proved PTA, these values for TB were 28.8％, 27.3％, and 43.9％, respectively. In patients with steady or worsening PTA, these values for TB were 5.7％, 32.3％, and 65.6％, respectively. Dynamic prognostic criteria were developed by combining the clinical course of PTA/TB and the clini-cal outcomes at 4 and 12 weeks after diagnosis in ACLF patients. Conclusions: We propose the following dynamic prognostic criteria: rapid progression, slow progression, rapid recovery, slow recovery, and slow persistence, which lay the foundation for precise prediction of prognosis and the improvement of ACLF therapy.
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