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2020, vol. 148, br. 3-4, str. 153-159
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Procena ishoda lečenja bolesnika sa akutizacijom hronične insuficijencije jetre primenom kliničkih skorova
Evaluation of treatment outcome in patients with acute-on-chronic liver failure using clinical scores
aUniverzitet u Beogradu, Medicinski fakultet + Klinički centar Srbije, Klinika za gastroenterohepatologiju, Beograd bKlinički centar Srbije, Klinika za gastroenterohepatologiju, Beograd cKlinički centar Srbije, Klinika za nefrologiju, Beograd dMayo Clinic Health System, Department of Medicine, Eau Claire, Wisconsin, USA + Mayo Clinic School of Medicine and Sciences, Rochester, Minnesota, USA
e-adresa: dragasevicsanja@gmail.com
Sažetak
Uvod/Cilj Rana identifikacija i intenzivna terapija su neophodne kod bolesnika sa akutizacijom hronične insuficijencije jetre (AHIJ) zbog veoma visokog rizika od smrtnosti. Precizna predikcija je presudna za određivanje stepena hitnosti i adekvatnost terapije s obzirom na mortalitet i kliničke resurse. Cilj naše studije bio je da odredimo tačne granične vrednosti različitih prognostičkih skorova u predikciji mortaliteta od AHIJ. Metode Ova prospektivna studija obuhvatila je bolesnike sa hroničnom insuficijencijom jetre (HIJ) hospitalizovane zbog dekompenzacije i kasnije dijagnostikovane AHIJ u jedinici intenzivne nege. Svi bolesnici su procenjeni prema različitim prognostičkim skorovima, uključujući Čajld-Pju, MELD Na, MELD, SOFA, APACHE II i CLIF C, koji su izračunati na prijemu. Rezultati Alkoholna bolest jetre bila je najčešći uzrok HIJ (77,9%), zatim virusna (8,6%), autoimuna (7,7%) i druga (5,8%). Ukupno 37,5% bolesnika je umrlo na kraju prvog meseca lečenja. Prosečne vrednosti Child-Pugh, MELD Na, MELD, SOFA, APACHE II i CLIF C su bile značajno veće kod bolesnika koji su umrli u odnosu na preživele (p < 0,05). CLIF C skor je imao najbolji učinak sa graničnom vrednošću od 50,5, senzitivnošću 94,9% i specifičnošću od 40%. Zaključci AHIJ predstavlja stanje sa visokom kratkoročnom smrtnošću. Od svih skorova koji su analizirani u našoj studiji, CLIF C se pokazao kao najbolji skor za predikciju krajnjeg mortaliteta bolesnika sa AHIJ.
Abstract
Introduction/Objective Due to a very high mortality risk, acute-on-chronic liver failure (ACLF) patients require early identification and intensive treatment. Precise prediction is crucial for determining the urgency degree and therapy appropriateness, considering high mortality and multitude of clinical resources. The aim of our study was to determine the exact cut-off values of various prognostic scores in the prediction of morality of ACLF. Methods This prospective study includes chronic liver disease (CLD) patients, admitted due to decompensation, that were subsequently diagnosed with ACLF at the Emergency unit. All patients were evaluated based on various prognostic scores, including Child-Pugh, MELD Na, MELD, SOFA, APACHE II, and CLIF C, which were calculated on admission. Results Alcoholic liver disease (ALD) was the most common underlying CLD cause (77.9%), followed by viral (8.6%), autoimmune (7.7%), and other causes (5.8%). A total of 37.5% of the patients died at the end of the first month of treatment. Average values of Child-Pugh, MELD Na, MELD, SOFA, APACHE II, and CLIF C scores were significantly higher in patients who died compared to survivors (p < 0.05). CLIF C score showed the best performance with a cut-off value of 50.5, with a sensitivity of 94.9% and specificity of 40%. Conclusion ACLF remains a condition with a high short-term mortality. Of all of the scores examined in our study, CLIF C proved to be the best scoring system for predicting short term and end of treatment mortality in patients with ACLF.
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