Patients with acute decompensation of cirrhosis or acute-on-chronic liver failure (ACLF) often require intensive care unit (ICU) admission for organ support. Existing research, mostly from specialized liver transplant centers, largely addresses short-term outcomes. Our aim was to evaluate in-hospital mortality and 1-year transplant-free survival after hospital discharge in the Netherlands. We conducted a nationwide observational cohort study, including patients with a history of cirrhosis or first complications of cirrhotic portal hypertension admitted to ICUs in the Netherlands between 2012 and 2020. The influence of ACLF grade at ICU admission on 1-year transplant-free survival after hospital discharge among hospital survivors was evaluated using unadjusted Kaplan-Meier survival curves and an adjusted Cox proportional hazard model. Out of the 3,035 patients, 1,819 (59.9%) had ACLF-3. 1,420 patients (46.8%) survived hospitalization after ICU admission. The overall probability of 1-year transplant-free survival after hospital discharge was 0.61 (95% CI 0.59-0.64). This rate varied with ACLF grade at ICU admission, being highest in patients without ACLF (0.71; 95% CI 0.66-0.76) and lowest in those with ACLF-3 (0.53 [95% CI 0.49-0.58]) (log-rank 0.0001). However, after adjusting for age, malignancy status and MELD score, ACLF grade at ICU admission was not associated with an increased risk of liver transplantation or death within 1 year after hospital discharge. In this nationwide cohort study, ACLF grade at ICU admission did not independently affect 1-year transplant-free survival after hospital discharge. Instead, age, presence of malignancy and the severity of liver disease played a more prominent role in influencing transplant-free survival after hospital discharge. Patients with acute-on-chronic liver failure often require intensive care unit (ICU) admission for organ support. In these patients, short-term mortality is high, but long-term outcomes of survivors remain unknown. Using a large nationwide cohort of ICU patients, we discovered that the severity of acute-on-chronic liver failure at ICU admission does not influence 1-year transplant-free survival after hospital discharge. Instead, age, malignancy status and overall severity of liver disease are more critical factors in determining their long-term survival.

中文翻译：

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荷兰因 ACLF 入住 ICU 出院后一年无移植生存率

肝硬化急性失代偿或慢性肝衰竭急性发作 (ACLF) 的患者通常需要入住重症监护病房 (ICU) 以获得器官支持。现有的研究主要来自专门的肝移植中心，主要解决短期结果。我们的目的是评估荷兰的院内死亡率和出院后 1 年无移植生存率。我们进行了一项全国性的观察性队列研究，纳入了 2012 年至 2020 年间入住荷兰 ICU 的有​​肝硬化病史或肝硬化门静脉高压首发并发症的患者。入住 ICU 时 ACLF 分级对术后 1 年无移植生存率的影响使用未调整的 Kaplan-Meier 生存曲线和调整的 Cox 比例风险模型评估医院幸存者的出院情况。在 3,035 名患者中，1,819 名 (59.9%) 患有 ACLF-3。 1,420 名患者（46.8%）在入住 ICU 后幸存。出院后 1 年无移植生存的总体概率为 0.61 (95% CI 0.59-0.64)。该比率随 ICU 入院时 ACLF 等级的不同而变化，在无 ACLF 的患者中最高 (0.71; 95% CI 0.66-0.76)，在 ACLF-3 的患者中最低 (0.53 [95% CI 0.49-0.58])（对数秩 0.0001） ）。然而，在调整年龄、恶性肿瘤状况和 MELD 评分后，入住 ICU 时的 ACLF 等级与出院后 1 年内肝移植或死亡风险增加无关。在这项全国性队列研究中，入住 ICU 时的 ACLF 等级并不独立影响出院后 1 年无移植生存率。相反，年龄、恶性肿瘤的存在和肝病的严重程度在影响出院后的无移植生存方面发挥着更重要的作用。慢性肝衰竭急性患者通常需要入住重症监护病房 (ICU) 以获得器官支持。这些患者的短期死亡率很高，但幸存者的长期结果仍然未知。通过对全国范围内的 ICU 患者进行大型队列研究，我们发现 ICU 入院时慢加急性肝衰竭的严重程度并不影响出院后 1 年无移植生存率。相反，年龄、恶性肿瘤状况和肝病的总体严重程度是决定其长期生存的更关键因素。