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】
目的：描述急性肝衰竭（acute liver failure）患者队列，并分析与死亡率相关的人口统计学及临床因素。
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全部患者。采用艾比美德系统（Epimed System）收集患者的临床及人口统计学资料，计算简化急性生理学评分3（SAPS 3）、序贯器官衰竭评分（SOFA）及终末期肝病模型评分（MELD）。估算比值比及95%置信区间，绘制各预后评分的受试者工作特征曲线，并针对预测死亡率最优的评分绘制Kaplan-Meier生存曲线（Kaplan-Meier survival curve）。
结果：本研究纳入的40例患者中，多数为女性（占比77.5%），最常见的病因为乙型病毒性肝炎（hepatitis B，n=13）。仅35%的患者接受了肝移植。院内死亡率为57.5%（95%CI：41.5~73.5）。在本次研究所评估的各项评分中，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）。
结论：入院最初24小时内的SOFA评分是预测患者不良预后的最优指标。