《2025年国际专家小组共识声明: 肝硬化患者器官衰竭的定义》摘译
DOI: 10.12449/JCH250909
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:陈佳负责文章翻译;曹竹君、谢青负责文章审校。
An excerpt of defining organ failures in patients with cirrhosis: Consensus statements (2025)
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摘要: 慢加急性肝衰竭(ACLF)是一种在肝硬化基础上,由急性打击诱导的多器官衰竭综合征,其特征为高感染风险、系统性炎症、多器官衰竭及高病死率。然而,现有主流肝病学会提出的器官衰竭定义彼此间存在差异。为进一步针对肝硬化患者制定标准化的器官衰竭标准,以美国肝病学会、欧洲肝病学会、亚太肝病学会核心专家为领导的国际专家小组,采用德尔菲法对肝硬化器官衰竭诊断标准制定了新的共识,旨在为ACLF诊断、预后评估和临床试验提供基准。该共识对肝衰竭、感染与免疫障碍、脑衰竭、肾衰竭、循环衰竭、呼吸衰竭及胃肠功能衰竭进行了明确定义,首次系统整合肝硬化相关的器官衰竭标准,为ACLF的机制研究,临床管理的标准化,药物开发,以及移植的优先级评估提供了核心框架。同时,共识明确了未来需要验证的动态指标(如胆红素变化、淋巴细胞/中性粒细胞比值)及需要探索的新型生物标志物。本文对该共识的核心内容进行摘译。Abstract: Acute-on-chronic liver failure (ACLF) is a syndrome of multi-organ failure in patients with liver cirrhosis triggered by acute insult(s), and it is characterized by a high risk of infection, systemic inflammation, multi-organ failure, and a high short-term mortality rate. However, there are differences in the definition of organ failure (OF) across major hepatology societies. In order to develop standardized OF criteria for patients with liver cirrhosis, an international panel of experts mainly from AASLD, EASL, and APASL developed new consensus statements on the diagnostic criteria for OF in liver cirrhosis, aiming to provide a basis for the diagnosis, prognostic evaluation, and clinical trials of ACLF. The consensus statements provide clear definitions for liver failure, infection and immune dysfunction, cerebral failure, renal failure, circulatory failure, respiratory failure, and gastrointestinal failure and systematically integrate the criteria for OF associated with liver cirrhosis for the first time, thereby establishing a core framework for research on ACLF mechanisms, standardization of clinical management, drug development, and assessment of priority for transplantation. Furthermore, the consensus statements identify the dynamic parameters that need to be validated in the future (such as the changes in bilirubin and lymphocyte-to-neutrophil ratio) and the novel biomarkers requiring further exploration. This article gives an excerpt of the core contents of the consensus statements.
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Key words:
- Liver Cirrhosis /
- Acute-on-Chronic Liver Failure /
- Organ Failure /
- Practice Guideline
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[1] BAJAJ JS, SHAWCROSS DL, CHOUDHURY A, et al. Defining organ failures in patients with cirrhosis: consensus statements[J]. Gastroenterology, 2025. DOI: 10.1053/j.gastro.2025.05.026.[ Epub ahead of print]. -
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