SOFA in the first 24 hours as an outcome predictor of acute liver failure

ABSTRACT Objective: To describe a cohort of patients with acute liver failure and to analyze the demographic and clinical factors associated with mortality. Methods: Retrospective cohort study in which all patients admitted for acute liver failure from July 28, 2012, to August 31, 2017, were included. Clinical and demographic data were collected using the Epimed System. The SAPS 3, SOFA, and MELD scores were measured. The odds ratios and 95% confidence intervals were estimated. Receiver operating characteristics curves were obtained for the prognostic scores, along with the Kaplan-Meier survival curve for the score best predicting mortality. Results: The majority of the 40 patients were female (77.5%), and the most frequent etiology was hepatitis B (n = 13). Only 35% of the patients underwent liver transplantation. The in-hospital mortality rate was 57.5% (95%CI: 41.5 - 73.5). Among the scores investigated, only SOFA remained associated with risk of death (OR = 1.37; 95%CI 1.11 - 1.69; p < 0.001). After SOFA stratification into < 12 and ≥ 12 points, survival was higher in patients with SOFA <12 (log-rank p < 0.001). Conclusion: SOFA score in the first 24 hours was the best predictor of fatal outcome.摘要 研究目的：描述急性肝衰竭患者队列，并分析与死亡率相关的人口统计学及临床因素。 研究方法：本研究为回顾性队列研究，纳入2012年7月28日至2017年8月31日期间因急性肝衰竭入院的所有患者。采用Epimed系统收集患者的临床及人口统计学资料，记录简化急性生理学评分3（SAPS 3）、序贯器官衰竭评分（SOFA）及终末期肝病模型（MELD）评分。计算比值比（OR）及95%置信区间（CI），绘制各预后评分的受试者工作特征（ROC）曲线，并针对预测死亡率效果最佳的评分绘制Kaplan-Meier生存曲线。 研究结果：本研究共纳入40例患者，其中女性占比77.5%，最常见的致病诱因为乙型病毒性肝炎（n=13）。仅35%的患者接受了肝移植手术。患者院内死亡率为57.5%（95%CI：41.5~73.5）。在本次研究评估的评分中，仅SOFA评分与死亡风险显著相关（OR=1.37；95%CI：1.11~1.69；P<0.001）。将SOFA评分按<12分与≥12分进行分层后，SOFA评分<12分的患者生存率更高（log-rank检验P<0.001）。 研究结论：入院24小时内的SOFA评分是预测患者不良预后的最佳指标。