Acute-on-chronic liver failure: consensus recommendations of the Asian Pacific Association for the Study of the Liver (APASL) 2014

Hepatology International - Tập 8 - Trang 453-471 - 2014
Shiv Kumar Sarin1, Chandan Kumar Kedarisetty1, Zaigham Abbas2, Deepak Amarapurkar3, Chhagan Bihari4, Albert C. Chan5, Yogesh Kumar Chawla6, A. Kadir Dokmeci7, Hitendra Garg1, Hasmik Ghazinyan8, Saeed Hamid9, Dong Joon Kim10, Piyawat Komolmit11, Suman Lata12, Guan Huei Lee13, Laurentius A. Lesmana14, Mamun Mahtab15, Rakhi Maiwall1, Richard Moreau16,17,18, Qin Ning19, Viniyendra Pamecha20, Diana Alcantara Payawal21, Archana Rastogi4, Salimur Rahman15, Mohamed Rela22, Anoop Saraya23, Didier Samuel24, Vivek Saraswat25, Samir Shah26, Gamal Shiha27, Brajesh Chander Sharma28, Manoj Kumar Sharma1, Kapil Sharma1, Amna Subhan Butt9, Soek Siam Tan29, Chitranshu Vashishtha1, Zeeshan Ahmed Wani1, Man-Fung Yuen30, Osamu Yokosuka31
1Department of Hepatology, Institute of Liver and Biliary Sciences, New Delhi, India
2Department of Hepatogastroenterology, Sindh Institute of Urology and Transplantation, Karachi, Pakistan
3Department of Gastroenterology and Hepatology, Bombay Hospital and Medical Research, Mumbai, India
4Department of Pathology, Institute of Liver and Biliary Sciences, New Delhi, India
5Division of Hepatobiliary and Pancreatic Surgery, and Liver Transplantation, Department of Surgery, The University of Hong Kong, Hong Kong, China
6Department of Hepatology, Post Graduate Institute of Medical Education and Research, Chandigarh, India
7Department of Gastroenterology, Ankara University School of Medicine, Ankara, Turkey
8Department of Hepatology, Nork Clinical Hospital of Infectious Diseases, Yerevan, Armenia
9Department of Medicine, Aga Khan University Hospital, Karachi, Pakistan
10Center for Liver and Digestive Diseases, Hallym University Chuncheon Sacred Heart Hospital, Chuncheon, Republic of Korea
11Division of Gastroenterology and Hepatology, Department of Medicine, Chulalongkorn University, Bangkok, Thailand
12Department of Nephrology, Institute of Liver and Biliary Sciences, New Delhi, India
13Department of Gastroenterology and Hepatology, National University Health System, Singapore, Singapore
14Division of Hepatology, University of Indonesia, Jakarta, Indonesia
15Department of Hepatology, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh
16Inserm, U1149, Centre de recherche sur l’Inflammation (CRI), Paris, France
17UMR_S 1149, Labex INFLAMEX, Université Paris Diderot Paris 7, Paris, France
18Département Hospitalo-Universitaire (DHU) UNITY, Service d’Hépatologie, Hôpital Beaujon, APHP, Clichy, France
19Department of Infectious Disease, Tongji Hospital of Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
20Department of Hepatobiliary Surgery, Institute of Liver and Biliary Sciences, New Delhi, India
21Department of Hepatology, Cardinal Santos Medical Center, Manila, Philippines
22Institute of Liver Diseases and Transplantation, Global Health city, Chennai, India
23Department of Gastroenterology, All India Institute of Medical Sciences, New Delhi, India
24INSERM, Centre Hépatobiliarie, Hôpital Paul Brousse, Villejuif, France
25Department of Gastroenterology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
26Department of Gastroenterology and Hepatology, Global Hospitals, Mumbai, India
27Department of Internal Medicine, Egyptian Liver Research Institute and Hospital, Cairo, Egypt
28Department of Gastroenterology, GB Pant Hospital, New Delhi, India
29Department of Gastroenterology and Hepatology, Selayang Hospital, Kepong, Malaysia
30Department of Medicine, The University of Hong Kong, Hong Kong, China
31Department of Gastroenterology and Nephrology, Graduate School of Medicine, Chiba University, Chiba, Japan

Tóm tắt

The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set up in 2004 on acute-on-chronic liver failure (ACLF) was published in 2009. Due to the rapid advancements in the knowledge and available information, a consortium of members from countries across Asia Pacific, “APASL ACLF Research Consortium (AARC),” was formed in 2012. A large cohort of retrospective and prospective data of ACLF patients was collated and followed up in this data base. The current ACLF definition was reassessed based on the new AARC data base. These initiatives were concluded on a 2-day meeting in February 2014 at New Delhi and led to the development of the final AARC consensus. Only those statements which were based on the evidence and were unanimously recommended were accepted. These statements were circulated again to all the experts and subsequently presented at the annual conference of the APASL at Brisbane, on March 14, 2014. The suggestions from the delegates were analyzed by the expert panel, and the modifications in the consensus were made. The final consensus and guidelines document was prepared. After detailed deliberations and data analysis, the original proposed definition was found to withstand the test of time and identify a homogenous group of patients presenting with liver failure. Based on the AARC data, liver failure grading, and its impact on the "Golden therapeutic Window," extra-hepatic organ failure and development of sepsis were analyzed. New management options including the algorithms for the management of coagulation disorders, renal replacement therapy, sepsis, variceal bleed, antivirals, and criteria for liver transplantation for ACLF patients were proposed. The final consensus statements along with the relevant background information are presented here.

Tài liệu tham khảo

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