Этиология и клинические особенности синдрома обострения хронической печеночной недостаточности у пациентов с острой декомпенсацией цирроза печени

Abstract

The aim - to determine the etiology and clinical features of the acute-on-chronic liver failure (ACLF) in patients with acute decompensation of liver cirrhosis (LC). Materials and methods. A retrospective analysis of the clinical features of ACLF was performed in 71 patients with LC, who died within 28 days of hospital stay. The etiology of the LC was determined, traditional clinical, laboratory and instrumental data were performed, the chronic liver failure organ failure score (CLIF OF S), chronic liver failure-consortium acute-on-chronic liver failure score (CLIF-C ACLF S), model for end stage liver disease score (MELD S) and Child-Pugh score (Ch-P S) were calculated. Results. Alcoholic genesis of LC was detected in 63.4% of patients, alcoholic in combination with metabolic (NAFLD) - in 15.5%, alcoholic in combination with viral - in 4,2%, metabolic - in 1,4%, viral - in 4, 2%, autoimmune - in 1,4%, drug - in 1,4%, unidentifiable - in 8.5%. Triggers for the development of ACLF were active alcoholism in 39.4% of patients, bacterial infection in 19.7%, esophageal bleeding in 15.5%, active HCV infection in 4.2%, autoimmune attack in 1,4%. ACLF grade 1 was revealed in 26.8%, ACLF grade 2 - in 19.7%, ACLF grade 3 - in 53.5% of patients. The frequency of organ failures were: liver - 73.2%, kidney - 54.9%, coagulation - 54.9%, cerebral - 21.6%, circulation - 18.3%, lungs - 11.3%. CLIF OF S, CLIF-C ACLF S significantly increased already at ACLF grade 2, and MELD S and Ch-P S - only at ACLF grade 3. Conclusion. The alcoholic genesis of LC was revealed in the most patients (63.4%) and active alcoholism was the trigger for ACLF development (39.4%). The most frequent clinical manifestations of ACLF were liver failure (73.2%), kidney (54.9%) and coagulation (54.9%). CLIF OF S, CLIF-C-ACLF S had better diagnostic and prognostic significance than MELD S and Ch-P S.