RESUMEN
Acute-on-chronic liver failure (ACLF) can be cured by liver transplantation; however, perioperative complications still affect posttransplant outcomes. In recent years, early rehabilitation for critical illness, liver disease, and surgery have significantly improved organ reserve function, surgery tolerance, and postoperative quality of life. They could also be applied in the perioperative period of liver transplantation in patients with ACLF. Therefore, the Transplantation Immunology Committee of Branch of Organ Transplantation Physician of Chinese Medical Doctor Association, the Organ Transplant Rehabilitation Committee of China Association Rehabilitation Medicine, and the Branch of Organ Transplantation Physician of Guangdong Medical Doctor Association conducted a comprehensive review of rehabilitation in end-stage liver disease, critical illness and surgical patients by summarizing current evidence and best clinical practices and proposed a practice consensus on evaluation of cardiopulmonary and physical function, rehabilitation or physiotherapies, as well as the safety concerns in perioperative liver transplant recipients. It will be a valuable resource for hepatologists, transplant surgeons, and intensivists as they care for ACLF patients during transplantation.
RESUMEN
Objective: To investigate the value of the Child-Pugh (CTP), ALBI, MELD, and MELD-Na scores in predicting acute-on-chronic liver failure (ACLF) in patients with hepatocellular carcinoma(HCC) after transcatheter arterial chemoembolization (TACE). Methods: Seven hundred and eleven patients with HCC who received their first TACE treatment at Guangxi Medical University Cancer Hospital between October 2013 and October 2015 were retrospectively analyzed. A Logistic regression analysis and receiver operating characteristic (ROC) curve were used to evaluate the efficacy of the four scoring models in predicting ACLF. Results: The results of the univariate and multivariate analysis showed that the four scoring models could independently predict the occurrence of ACLF after TACE. The ROC curve analysis showed that the area under the ROC curve (AUC) of ALBI was significantly higher than the other three scores (P5.5, ALBI >-2.29, MELD >8.08 and MELD-Na >8.08 was higher than those with scores lower than the cut-off values (P0.001). Conclusions: The child-Pugh, ALBI, MELD, and MELD-Na scores have certain predictive value for ACLF after TACE treatment, with ALBI having the best predictive value.
RESUMEN
Objective@#To evaluate the prognostic value of neutrophil-to-lymphocyte ratio (NLR) in patients with acute-on-chronic liver failure (ACLF) after glucocorticoid therapy.@*Methods@#Thirty-six patients with acute-on-chronic liver failure (ACLF) were treated with glucocorticoid therapy, of whom 23 patients in the survival group and the other in the deceased group (n=13). The changes of white blood cells, neutrophils, lymphocytes, NLR, total bilirubin (TBil), prothrombin activity (PTA), international normalized ratio (INR) were observed before, during and after treatment, and the relationship between NLR and prognosis was analyzed.@*Results@#NLR after glucocorticoid treatment, the survival group 3.95±2.65, the deceased group 12.79±10.66, there was significant difference between the two groups (P<0.001). According to univariate and multivariate logisitic regression analysis, NLR ratio was one of the independent factor in ACLF. ROC curve showed the AUC of NLR in patients with ACLF 0.868(95%CI: 0.743-0.993). After glucocorticoid treatment, the survival rate of NLR<3.315 patients with acute liver failure was high.@*Conclusions@#NLR is one of the important indexes for evaluating the prognosis of ACLF patients with ACLF due to glucocorticoid therapy.