INTRODUCTION The prevalence of metabolic dysfunction-associated fatty liver disease (MAFLD) and its complication, MAFLD-related acute-on-chronic liver failure (MAFLD-ACLF), is rising. Yet, factors determining patient outcomes in MAFLD-ACLF remain understudied. METHODS Patients with MAFLD-ACLF were recruited from the Asian Pacific Association for the Study of the Liver-ACLF Research Consortium (AARC registry). The diagnosis of MAFLD-ACLF was made when the treating unit had identified the etiology of chronic liver disease as MAFLD (or previous nomenclature such as non-alcoholic fatty liver disease, non-alcoholic steatohepatitis, or non-alcoholic steatohepatitis-cirrhosis). Patients with coexisting other etiologies of chronic liver disease (such as alcohol, hepatitis B virus, hepatitis C virus, etc.) were excluded. Data were randomly split into derivation (n = 258) and validation (n = 111) cohorts at a 70:30 ratio. The primary outcome was 90-day mortality. Only the baseline clinical, laboratory features and severity scores were considered. RESULTS The derivation group had 258 patients; 60% were male, with a mean age of 53. Diabetes was noted in 27% and hypertension in 29%. The dominant precipitants included viral hepatitis (hepatitis A virus and hepatitis E virus, 32%), drug-induced injury (drug-induced liver injury, 29%), and sepsis (23%). Model for End-Stage Liver Disease-Sodium (MELD-Na) and AARC scores on admission averaged 32 ± 6 and 10.4 ± 1.9. At 90 days, 51% survived. Nonviral precipitant, diabetes, bilirubin, international normalized ratio, and encephalopathy were independent factors influencing mortality. Adding diabetes and precipitant to MELD-Na and AARC scores, the novel MAFLD-MELD-Na score (+12 for diabetes, +12 for nonviral precipitant), and MAFLD-AARC score (+5 for each) were formed. These outperformed the standard scores in both cohorts. DISCUSSION Almost half of patients with MAFLD-ACLF die within 90 days. Diabetes and nonviral precipitants such as drug-induced liver injury and sepsis lead to adverse outcomes. The new MAFLD-MELD-Na and MAFLD-AARC scores provide reliable 90-day mortality predictions for patients with MAFLD-ACLF.

中文翻译：

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糖尿病、药物性肝损伤和脓毒症对代谢功能障碍相关脂肪性肝病相关慢性急性肝衰竭结果的影响。


简介 代谢功能障碍相关的脂肪肝 (MAFLD) 及其并发症、MAFLD 相关的慢性肝衰竭 (MAFLD-ACLF) 的患病率正在上升。然而，决定 MAFLD-ACLF 患者预后的因素仍未得到充分研究。方法 MAFLD-ACLF 患者是从亚太肝脏研究协会-ACLF 研究联盟（AARC 注册中心）招募的。当治疗单位将慢性肝病的病因确定为 MAFLD（或以前的术语，如非酒精性脂肪肝病、非酒精性脂肪性肝炎或非酒精性脂肪性肝炎-肝硬化）时，即可做出 MAFLD-ACLF 的诊断。排除同时存在其他慢性肝病病因（如酒精、乙型肝炎病毒、丙型肝炎病毒等）的患者。数据按 70:30 的比例随机分为推导组 (n = 258) 和验证组 (n = 111)。主要结局是 90 天死亡率。仅考虑基线临床、实验室特征和严重程度评分。结果推导组258例患者； 60% 为男性，平均年龄 53 岁。27% 的人患有糖尿病，29% 的人患有高血压。主要诱发因素包括病毒性肝炎（甲型肝炎病毒和戊型肝炎病毒，32%）、药物性损伤（药物性肝损伤，29%）和败血症（23%）。入院时的终末期肝病钠模型 (MELD-Na) 和 AARC 评分平均为 32 ± 6 和 10.4 ± 1.9。 90 天时，51% 存活。非病毒诱因、糖尿病、胆红素、国际标准化比值和脑病是影响死亡率的独立因素。 将糖尿病和沉淀物添加到 MELD-Na 和 AARC 评分中，形成新的 MAFLD-MELD-Na 评分（糖尿病+12，非病毒沉淀物+12）和 MAFLD-AARC 评分（各+5）。这些成绩都超过了两个队列的标准分数。讨论 几乎一半的 MAFLD-ACLF 患者会在 90 天内死亡。糖尿病和药物性肝损伤和败血症等非病毒诱发因素会导致不良后果。新的 MAFLD-MELD-Na 和 MAFLD-AARC 评分为 MAFLD-ACLF 患者提供可靠的 90 天死亡率预测。