Dynamic analysis of acute deterioration in chronic liver disease patients using modified quick sequential organ failure assessment
2
조회
0
다운로드
2
인용
0
참고문헌
키워드
초록
Background/Aims: Quick sequential organ failure assessment (qSOFA) is believed to identify patients at risk of poor outcomes in those with suspected infection. We aimed to evaluate the ability of modified qSOFA (m-qSOFA) to identify high-risk patients among those with acutely deteriorated chronic liver disease (CLD), especially those with acute-on-chronic liver failure (ACLF). Methods: We used data from both the Korean Acute-on-Chronic Liver Failure (KACLiF) and the Asian Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) cohorts. qSOFA was modified by replacing the Glasgow Coma Scale with hepatic encephalopathy, and an m-qSOFA ≥2 was considered high. Results: Patients with high m-qSOFA had a significantly lower 1-month transplant-free survival (TFS) in both cohorts and higher organ failure development in KACLiF than those with low m-qSOFA (Ps<0.05). Subgroup analysis by ACLF showed that patients with high m-qSOFA had lower TFS than those with low m-qSOFA. m-qSOFA was an independent prognostic factor (hazard ratios, HR=2.604, 95% confidence interval, CI 1.353–5.013, P=0.004 in KACLiF and HR=1.904, 95% CI 1.484–2.442, P<0.001 in AARC). The patients with low m-qSOFA at baseline but high m-qSOFA on day 7 had a significantly lower 1-month TFS than those with high m-qSOFA at baseline but low m-qSOFA on day 7 (52.6% vs. 89.4%, P<0.001 in KACLiF and 26.9% vs. 61.5%, P<0.001 in AARC). Conclusions: Baseline and dynamic changes in m-qSOFA may identify patients with a high risk of developing organ failure and short-term mortality among CLD patients with acute deterioration.
Abstract
Background/Aims: Quick sequential organ failure assessment (qSOFA) is believed to identify patients at risk of poor outcomes in those with suspected infection. We aimed to evaluate the ability of modified qSOFA (m-qSOFA) to identify high-risk patients among those with acutely deteriorated chronic liver disease (CLD), especially those with acute-on-chronic liver failure (ACLF). Methods: We used data from both the Korean Acute-on-Chronic Liver Failure (KACLiF) and the Asian Pacific Association for the Study of the Liver ACLF Research Consortium (AARC) cohorts. qSOFA was modified by replacing the Glasgow Coma Scale with hepatic encephalopathy, and an m-qSOFA ≥2 was considered high. Results: Patients with high m-qSOFA had a significantly lower 1-month transplant-free survival (TFS) in both cohorts and higher organ failure development in KACLiF than those with low m-qSOFA (Ps<0.05). Subgroup analysis by ACLF showed that patients with high m-qSOFA had lower TFS than those with low m-qSOFA. m-qSOFA was an independent prognostic factor (hazard ratios, HR=2.604, 95% confidence interval, CI 1.353–5.013, P=0.004 in KACLiF and HR=1.904, 95% CI 1.484–2.442, P<0.001 in AARC). The patients with low m-qSOFA at baseline but high m-qSOFA on day 7 had a significantly lower 1-month TFS than those with high m-qSOFA at baseline but low m-qSOFA on day 7 (52.6% vs. 89.4%, P<0.001 in KACLiF and 26.9% vs. 61.5%, P<0.001 in AARC). Conclusions: Baseline and dynamic changes in m-qSOFA may identify patients with a high risk of developing organ failure and short-term mortality among CLD patients with acute deterioration.
참고문헌 (32)
- Arroyo V, "Acute-on-chronic liver failure in cirrhosis", Nat Rev Dis Primers, 2, pp.16041~ (2016)
- Sarin SK, "Acute-on-chronic liver failure : consensus recommendations of the Asian Pacific association for the study of the liver(APASL) : an update", Hepatol Int, 13, pp.353~390 (2019)
- Choudhury A, "Liver failure determines the outcome in patients of acute-on-chronic liver failure(ACLF) : comparison of APASL ACLF research consortium(AARC)and CLIF-SOFA models", Hepatol Int, 11, pp.461~471 (2017)
- Moreau R, "Acute-on-chronic liver failure is a distinct syndrome that develops in patients with acute decompensation of cirrhosis", Gastroenterology, 144, pp.1426~1437 (2013)
- Arroyo V, "The systemic inflammation hypothesis : Towards a new paradigm of acute decompensation and multiorgan failure in cirrhosis", J Hepatol, 74, pp.670~685 (2021)
- Abbas N, "Acuteon-chronic liver failure(ACLF)in 2022 : have novel treatment paradigms already arrived?", Expert Rev Gastroenterol Hepatol, 16, pp.639~652 (2022)
- Fernández J, "Bacterial and fungal infections in acute-on-chronic liver failure : prevalence, characteristics and impact on prognosis", Gut, 67, pp.1870~1880 (2018)
- Singer M, "The third international consensus definitions for sepsis and septic shock(Sepsis-3)", JAMA, 315, pp.801~810 (2016)
- Augustinho FC, "Applicability of Sepsis-3 criteria and quick Sequential Organ Failure Assessment in patients with cirrhosis hospitalised for bacterial infections", Liver Int, 39, pp.307~315 (2019)
- Kim JH, "Reappraisal of sepsis-3 and CLIF-SOFA as predictors of mortality in patients with cirrhosis and infection presenting to the emergency department : A multicenter study", Clin Mol Hepatol, 28, pp.540~552 (2022)
- Piano S, "Assessment of Sepsis-3 criteria and quick SOFA in patients with cirrhosis and bacterial infections", Gut, 67, pp.1892~1899 (2018)
- Son J, "The quick sepsis-related organ failure score has limited value for predicting adverse outcomes in sepsis patients with liver cirrhosis", Korean J Intern Med, 35, pp.861~872 (2020)
- Vincent JL, "The SOFA(Sepsis-related Organ Failure Assessment)score to describe organ dysfunction", failure. On behalf of the Working Group on Sepsis-Related Problems of the European Society of Intensive Care Medicine, 1996, pp.22, 707~710
- Jalan R, "Acute-on chronic liver failure", J Hepatol, 57, pp.1336~1348 (2012)
- Costa E Silva PP, "Comparison of general and liver-specific prognostic scores in their ability to predict mortality in cirrhotic patients admitted to the intensive care unit", Can J Gastroenterol Hepatol, 2021, pp.9953106~ (2021)
- Sy E, "Prognostication of critically ill patients with acute-on-chronic liver failure using the Chronic Liver Failure-Sequential Organ Failure Assessment : A Canadian retrospective study", J Crit Care, 36, pp.234~239 (2016)
- McPhail MJ, "Increased survival for patients with cirrhosis and organ failure in liver intensive care and validation of the chronic liver failure-sequential organ failure scoring system", Clin Gastroenterol Hepatol, 13, pp.1353~1360 (2015)
- Suk KT, "Revision and update on clinical practice guideline for liver cirrhosis", Korean J Hepatol, 18, pp.1~21 (2012)
- Choudhury A, "Systemic inflammatory response syndrome in acute-on-chronic liver failure : Relevance of ‘golden window’ : A prospective study", J Gastroenterol Hepatol, 32, pp.1989~1997 (2017)
- Sanyal AJ, "Endpoints and clinical trial design for nonalcoholic steatohepatitis", Hepatology, 54, pp.344~353 (2011)
- Kim WR, "Hyponatremia and mortality among patients on the liver-transplant waiting list", N Engl J Med, 359, pp.1018~1026 (2008)
- Praktiknjo M, "Cardiodynamic state is associated with systemic inflammation and fatal acute-on-chronic liver failure", Liver Int, 40, pp.1457~1466 (2020)
- Turco L, "Cardiopulmonary hemodynamics and Creactive protein as prognostic indicators in compensated and decompensated cirrhosis", J Hepatol, 68, pp.949~958 (2018)
- Clària J, "Systemic inflammation in decompensated cirrhosis : Characterization and role in acute-on-chronic liver failure", Hepatology, 64, pp.1249~1264 (2016)
- Katoonizadeh A, "Early features of acute-on-chronic alcoholic liver failure : a prospective cohort study", Gut, 59, pp.1561~1569 (2010)
- Müller M, "qSOFA score not predictive of in-hospital mortality in emergency patients with decompensated liver cirrhosis", Med Klin Intensivmed Notfmed, 114, pp.724~732 (2019)
- Choi C, "Relationship between etiology of cirrhosis and survival among patients hospitalized in intensive care units", Mayo Clin Proc, 97, pp.274~284 (2022)
- Korean Association for the Study of the Liver(KASL), "KASL clinical practice guidelines for liver cirrhosis : Varices, hepatic encephalopathy, and related complications", Clin Mol Hepatol, 26, pp.83~127 (2020)
- Raith EP, "Prognostic accuracy of the SOFA score, SIRS criteria, and qSOFA score for in-hospital mortality among adults with suspected infection admitted to the intensive care unit", JAMA, 317, pp.290~300 (2017)
- Donnelly JP, "Application of the Third International Consensus Definitions for Sepsis(Sepsis-3)Classification : a retrospective populationbased cohort study", Lancet Infect Dis, 17, pp.661~670 (2017)
- Freund Y, "Prognostic accuracy of Sepsis-3criteria for in-hospital mortality among patients with suspected infection presenting to the emergency department", JAMA, 317, pp.301~308 (2017)
- Serafim R, "A comparison of the Quick-SOFA and systemic inflammatory response syndrome criteria for the diagnosis of Sepsis and prediction of mortality : A systematic review and meta-analysis", Chest, 153, pp.646~655 (2018)