Gut and liver · 2026
Liver Failure versus Organ Failure in Acute-on-Chronic Liver Failure: Sequence and Consequence.
СтатьяНазвание и аннотация: Перевод в очереди
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Chang Young, Jang Jae Young, Jeong Soung Won, Song Do Seon, Kim Hee Yeon, Jung Young Kul, Kim Tae Hyung, Yim Hyung Joon, Yoon Eileen L, Suk Ki Tae, Yoo Jeong-Ju, Kim Sang Gyune, Kim Moon Young, Kim Sung-Eun, Kim Jung-Hee, Park Jung Gil, Kim Won, Kim Dong Joon, Korean Acute-on-Chronic Liver Failure (KACLiF) Study Group
Аннотация
BACKGROUND/AIMS: Acute-on-chronic liver failure (ACLF) is characterized by the acute decompensation of the liver in patients with preexisting chronic liver disease or cirrhosis, often resulting in multiorgan failure and high short-term mortality. This study aimed to investigate the sequence of organ failures, particularly liver and renal failure, and their impact on the short-term survival in ACLF patients.
METHODS: We analyzed data from 1,765 patients in a prospective Korean ACLF cohort, focusing on the timing of liver and renal failures. Overall survival (OS) was assessed using Kaplan-Meier survival analysis with the log-rank test, and multivariate analysis was performed using a Cox proportional hazards model.
RESULTS: Patients with initial liver failure had significantly worse OS compared to those without liver failure (adjusted hazard ratio [aHR], 3.6; p=0.008), and those who developed liver failure during the disease course had an even poorer prognosis (aHR, 5.7; p=0.002). There was no significant difference in OS between patients without renal failure and those with initial renal failure (aHR, 0.8; p=0.508). However, renal failure that developed during hospitalization was associated with a worse prognosis (aHR, 1.9; p=0.056). Patients with initial renal failure had significantly better OS than those with initial liver failure (aHR, 2.4; p=0.040).
CONCLUSIONS: Organ failure developing during hospitalization is more detrimental than failure present at admission. ACLF with initial renal failure has a better prognosis than ACLF with initial liver failure. ACLF patients with initial renal failure have a 28-day survival rate exceeding 90% if renal failure is present initially; however, this rate significantly decreases if renal failure occurs during hospitalization.
METHODS: We analyzed data from 1,765 patients in a prospective Korean ACLF cohort, focusing on the timing of liver and renal failures. Overall survival (OS) was assessed using Kaplan-Meier survival analysis with the log-rank test, and multivariate analysis was performed using a Cox proportional hazards model.
RESULTS: Patients with initial liver failure had significantly worse OS compared to those without liver failure (adjusted hazard ratio [aHR], 3.6; p=0.008), and those who developed liver failure during the disease course had an even poorer prognosis (aHR, 5.7; p=0.002). There was no significant difference in OS between patients without renal failure and those with initial renal failure (aHR, 0.8; p=0.508). However, renal failure that developed during hospitalization was associated with a worse prognosis (aHR, 1.9; p=0.056). Patients with initial renal failure had significantly better OS than those with initial liver failure (aHR, 2.4; p=0.040).
CONCLUSIONS: Organ failure developing during hospitalization is more detrimental than failure present at admission. ACLF with initial renal failure has a better prognosis than ACLF with initial liver failure. ACLF patients with initial renal failure have a 28-day survival rate exceeding 90% if renal failure is present initially; however, this rate significantly decreases if renal failure occurs during hospitalization.