Martin S. Schulz, Jan Mengers, Wenyi Gu, Andreas Drolz, Philip Ferstl, Alex Amoros, Frank Erhard Uschner, Nora Ackermann, Georg Guttenberg, Alexander David Roger Queck, Maximilian Brol, Christiana Graf, Philipp Clemens Stoffers, Anna-Lena Laguna de la Vera, Carla-Luisa Elsa Cremonese, Hans-Peter Erasmus, Martin-Walter Welker, Achim Bernd Grünewaldt, Vicente Arroyo, Jörg Bojunga, Javier Fernandez, Stefan Zeuzem, Johannes Kluwe, Kai-Henrik Peiffer, Christoph Welsch, Valentin Fuhrmann, Gernot Gerhard Ulrich Rohde, Jonel Trebicka
- Background & Aims: In ACLF patients, an adequate risk stratification is essential, especially for liver transplant allocation, since ACLF is associated with high short-term mortality. The CLIF-C ACLF score is the best prognostic model to predict outcome in ACLF patients. While lung failure is generally regarded as signum malum in ICU care, this study aims to evaluate and quantify the role of pulmonary impairment on outcome in ACLF patients.
Methods: In this retrospective study, 498 patients with liver cirrhosis and admission to IMC/ICU were included. ACLF was defined according to EASL-CLIF criteria. Pulmonary impairment was classified into three groups: unimpaired ventilation, need for mechanical ventilation and defined pulmonary failure. These factors were analysed in different cohorts, including a propensity score-matched ACLF cohort.
Results: Mechanical ventilation and pulmonary failure were identified as independent risk factors for increased short-term mortality. In matched ACLF patients, the presence of pulmonary failure showed the highest 28-day mortality (83.7%), whereas mortality rates in ACLF with mechanical ventilation (67.3%) and ACLF without pulmonary impairment (38.8%) were considerably lower (p < .001). Especially in patients with pulmonary impairment, the CLIF-C ACLF score showed poor predictive accuracy. Adjusting the CLIF-C ACLF score for the grade of pulmonary impairment improved the prediction significantly.
Conclusions: This study highlights that not only pulmonary failure but also mechanical ventilation is associated with worse prognosis in ACLF patients. The grade of pulmonary impairment should be considered in the risk assessment in ACLF patients. The new score may be useful in the selection of patients for liver transplantation.
MetadatenAuthor: | Martin S. SchulzORCiD, Jan MengersGND, Wenyi GuORCiDGND, Andreas DrolzORCiDGND, Philip FerstlORCiDGND, Alex Amoros, Frank Erhard UschnerORCiDGND, Nora AckermannGND, Georg Guttenberg, Alexander David Roger QueckORCiDGND, Maximilian BrolORCiDGND, Christiana GrafORCiDGND, Philipp Clemens StoffersORCiDGND, Anna-Lena Laguna de la VeraGND, Carla-Luisa Elsa CremoneseGND, Hans-Peter Erasmus, Martin-Walter WelkerGND, Achim Bernd GrünewaldtGND, Vicente ArroyoORCiD, Jörg BojungaGND, Javier FernandezGND, Stefan ZeuzemORCiDGND, Johannes KluweGND, Kai-Henrik PeifferORCiDGND, Christoph WelschORCiDGND, Valentin Fuhrmann, Gernot Gerhard Ulrich RohdeORCiDGND, Jonel TrebickaORCiDGND |
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URN: | urn:nbn:de:hebis:30:3-735066 |
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DOI: | https://doi.org/10.1111/liv.15343 |
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ISSN: | 1478-3231 |
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Parent Title (English): | Liver international |
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Publisher: | Wiley-Blackwell |
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Place of publication: | Oxford |
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Document Type: | Article |
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Language: | English |
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Date of Publication (online): | 2022/06/21 |
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Date of first Publication: | 2022/06/21 |
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Publishing Institution: | Universitätsbibliothek Johann Christian Senckenberg |
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Release Date: | 2023/04/14 |
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Tag: | ACLF; CLIF-C ACLF score; CLIF-C ACLF-R score; acute-on-chronic liver failure; mechanical ventilation; pulmonary failure; respiratory failure |
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Volume: | 43 |
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Issue: | 1 |
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Page Number: | 14 |
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First Page: | 180 |
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Last Page: | 193 |
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Note: | Open Access funding enabled and organized by Projekt DEAL. |
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HeBIS-PPN: | 50891924X |
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Institutes: | Medizin |
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Dewey Decimal Classification: | 6 Technik, Medizin, angewandte Wissenschaften / 61 Medizin und Gesundheit / 610 Medizin und Gesundheit |
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Sammlungen: | Universitätspublikationen |
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Licence (German): | Creative Commons - CC BY - Namensnennung 4.0 International |
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