만성 간질환에서의 급성 장기부전
Acute-on-Chronic Liver Failure
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참고문헌
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초록
간경변 환자는 중환자실에서의 치료가 필요한 경우가 많지만 최근 20년 동안 중환자실에서의 사망률이 크게 줄지 않아[7], 이를 개선시키기 위한 관점에서 간이식 이외에는 경과와 예후를 반전시키기 어려운 비대상 간경변과 반전이 가능한 ACLF를 가려내려는 것이 필요해진 것이다. 이 종설은새로운 증후군으로서의 ACLF에 대한 이해를 돕고자 기획되었다.
Abstract
Acute-on-chronic liver failure (ACLF) is increasingly recognized as a distinct disease entity associated with acute deterioration of liver function in patients with chronic liver disease. Although no widely accepted diagnostic criteria for ACLF are yet available, the definitions of the Asian-Pacific Association for the Study of the Liver (APASL) ACLF Research Consortium (AARC) and the European Association for the Study of the Liver (EASL) Chronic Liver Failure Consortium (CLIF-C) are commonly employed. However, the AARC and CLIF-C criteria are based on fundamentally different features, rendering among-study comparisons difficult. The areas of uncertainty include the definition and extent of heterogeneity of ACLF, ambiguities in terms of the underlying liver disease, and whether infection or sepsis may precipitate the condition. Although the detailed pathogenesis of ACLF remains to be elucidated, changes in host responses to injury, infection, and uncontrolled inflammation play important roles. The “predisposition, infection/inflammation, response, organ failure” (PIRO) concept used to evaluate sepsis may be valuable when it is sought to describe the pathophysiology and clinical features of ACLF. Currently, treatment is limited to organ support but a better understanding of the pathophysiology is likely to lead, in future, to the discovery of novel biomarkers and the development of new therapeutic strategies.
참고문헌 (27)
- Hernaez R, "Acute-on-chronic liver failure: an update", Gut, 66, pp.541~553 (2017)
- Sarin SK, "Acute-on-chronic liver failure: terminology, mechanisms and management", Nat Rev Gastroenterol Hepatol, 13, pp.131~149 (2016)
- Bernal W, "Acute-on-chronic liver failure", Lancet, 386, pp.1576~1587 (2015)
- Arroyo V, "Acute-on-chronic liver failure:a new syndrome that will re-classify cirrhosis", J Hepatol, 62(1 Suppl), pp.S131~S143 (2015)
- Gustot T, "Clinical course of acute-on-chronic liver failure syndrome and effects on prognosis", Hepatology, 62, pp.243~252 (2015)
- Jalan R, "Acute-on chronic liver failure", J Hepatol, 57, pp.1336~1348 (2012)
- Olson JC, "Intensive care of the patient with cirrhosis", Hepatology, 54, pp.1864~1872 (2011)
- Kim TY, "Acute-on-chronic liver failure", Clin Mol Hepatol, 19, pp.349~359 (2013)
- "AASLD Position Paper:Introduction to the Revised American Association for the Study of Liver Diseases Position Paper on Acute Liver Failure 2011" (2011)[URL]
- Stravitz RT, "Management of acute liver failure", Nat Rev Gastroenterol Hepatol, 6, pp.542~553 (2009)
- Olson JC, "Acute-on-chronic liver failure: concept, natural history, and prognosis", Curr Opin Crit Care, 17, pp.165~169 (2011)
- Sarin SK, "Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the study of the liver (APASL)", Hepatol Int, 3, pp.269~282 (2009)
- Ohnishi H, "Acute-on-chronic liver failure", Ryoikibetsu Shokogun Shirizu, (7), pp.217~219 (1995)
- Jalan R, "Acute-on-chronic liver failure: pathophysiological basis of therapeutic options", Blood Purif, 20, pp.252~261 (2002)
- Sen S, "The pathophysiological basis of acute-on-chronic liver failure", Liver, 22(Suppl 2), pp.5~13 (2002)
- Wlodzimirow KA, "A systematic review on prognostic indicators of acute on chronic liver failure and their predictive value for mortality", Liver Int, 33, pp.40~52 (2013)
- 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)
- Bajaj JS, "Defining acute-on-chronic liver failure: will East and West ever meet?", Gastroenterology, 144, pp.1337~1339 (2013)
- Sarin SK, "Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL)2014", Hepatol Int, 8, pp.453~471 (2014)
- Kim TY, "Characteristics and discrepancies in acute-on-chronic liver failure: need for a unified definition", PLoS One, 11, pp.e0146745~ (2016)
- Moreno RP, "Sepsis mortality prediction based on predisposition, infection and response", Intensive Care Med, 34, pp.496~504 (2008)
- Jalan R, "Role of predisposition, injury, response and organ failure in the prognosis of patients with acute-on-chronic liver failure: a prospective cohort study", Crit Care, 16, pp.R227~ (2012)
- "American College of Chest Physicians", Society of Critical Care Medicine Consensus Conference: definitions for sepsis and organ failure and guidelines for the use of innovative therapies in sepsis, 1992, pp.20, 864~874
- Malik R, "Infection and inflammation in liver failure: two sides of the same coin", J Hepatol, 51, pp.426~429 (2009)
- Wasmuth HE, "Patients with acute on chronic liver failure display 'sepsis-like' immune paralysis", J Hepatol, 42, pp.195~201 (2005)
- Gustot T, "Severe sepsis in cirrhosis", Hepatology, 50, pp.2022~2033 (2009)
- Garg V, "Granulocyte colony-stimulating factor mobilizes CD34(+) cells and improves survival of patients with acute-on-chronic liver failure", Gastroenterology, 142, pp.505~512 (2012)